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Andronic O, Germann C, Jud L, Imhoff FB, Fröhlich S, Scherr J, Spörri J, Zingg PO. How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort. INTERNATIONAL ORTHOPAEDICS 2024; 48:2007-2015. [PMID: 38684549 PMCID: PMC11246315 DOI: 10.1007/s00264-024-06202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Symptomatic hips with borderline hip dysplasia (BHD) morphology pose a challenge in differentiating stable from unstable hips. The current study aims to compare indirect radiographic signs of instability in a symptomatic BHD population to those in a healthy cohort. METHODS The study group consisted of patients with a lateral centre-edge angle (LCEA) with values 18° ≤ LCEA < 25° who underwent corrective periacetabular osteotomy (PAO) and reported an improvement in patient-reported outcome measures (PROMs). The comparison group consisted of a healthy cohort of athletes who did not complain of any hip-related symptoms and who had normal values of their hip morphological parameters (LCEA, acetabular index (AI°), alpha angle (α°), femoral version, acetabular version). Indirect signs of instability consisting of the femoro-epiphyseal acetabular roof index (FEAR), iliocapsularis-to-rectus-femoris (IC/RF) ratio and labral dimensions (height-to-length ratio) were assessed in both groups. Partial Pearson correlation, logistic multiple regression analysis and Receiver-Operating Characteristic (ROC) curve analysis were performed to determine correlations, as well as the sensitivity and specificity of these signs to differentiate between healthy hips and BHD. RESULTS On binary logistic multiple regression analysis, the FEAR Index was the only independent predictor to differentiate between BHD and healthy hips (p < 0.001). The IC/RF ratio did not achieve significance. The calculated area under the curve (AUC) was 0.93 (0.87 - 0.99, CI 95%, p < 0.001) for the FEAR Index and 0.81 (0.70 - 0.92, CI 95%, p < 0.001) for the height-length ratio. Using the predefined cut-off values (dysplastic-FEAR Index ≥ 5° or labral height-to-length ratio ≤ 0.5), 27% sensitivity/100% specificity and 20% sensitivity/ 100% specificity, were achieved. ROC analysis provided the following new thresholds: FEAR Index ≥ -5° (73% sensitivity/97% specificity); labral height-to-length ratio ≤ 0.8 (70% sensitivity, 79% specificity). CONCLUSION In our cohort, the FEAR index was an independent parameter that could differentiate between borderline dysplastic and asymptomatic hips. The previously published values for both the FEAR index and labral hypertrophy ratio had a poor sensitivity in differentiating symptomatic unstable BHD from healthy hips. The cut-off values of ≥ -5° (FEAR index) and ≤ 0.8 (labral height-to-length ratio) provided acceptable sensitivity and specificity when comparing to morphological healthy hips.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland.
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
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van Dooren B, Peters RM, Visser D, van Steenbergen LN, Bos PK, Zijlstra WP. Femoral Neck Design Does Not Impact Revision Risk After Primary Total Hip Arthroplasty Using a Dual Mobility Cup. Arthroplast Today 2024; 25:101281. [PMID: 38292143 PMCID: PMC10826135 DOI: 10.1016/j.artd.2023.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 02/01/2024] Open
Abstract
Background The use of dual mobility (DM) cups has increased quickly. It is hypothesized that femoral neck taper geometry may be involved in the risk of prosthetic impingement and DM cup revision. We aim to (1) explore the reasons for revision of DM cups or head/liners and (2) explore whether certain femoral neck characteristics are associated with a higher risk of revision of DM cups. Methods Primary total hip arthroplasties with a DM cup registered in the Dutch Arthroplasty Register between 2007 and 2021 were identified (n = 7603). Competing risk survival analyses were performed, with acetabular component and head/liner revision as the primary endpoint. Reasons for revision were categorized in cup-/liner-related revisions (dislocation, liner wear, acetabular loosening). Femoral neck characteristics were studied to assess whether there is an association between femoral neck design and the risk of DM cup/liner revision. Multivariable Cox proportional hazard analyses were performed. Results The 5- and 10-year crude cumulative incidence of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was 0.5% (CI 0.4-0.8) and 1.9% (CI 1.3-2.8), respectively. After adjusting for confounders, we found no association between the examined femoral neck characteristics (alloy used, neck geometry, CCD angle, and surface roughness) and the risk for revision for dislocation, wear, and acetabular loosening. Conclusions The risk of DM cup or head/liner revision for dislocation, wear, and acetabular loosening was low. We found no evidence that there is an association between femoral neck design and the risk of cup or head/liner revision.
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Affiliation(s)
- Bart van Dooren
- Department of Orthopaedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Rinne M. Peters
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
- Department of Orthopedic surgery, Martini Hospital, Groningen, The Netherlands
| | - David Visser
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - P Koen Bos
- Department of Orthopedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
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Soliman MM, Islam MT, Chowdhury MEH, Alqahtani A, Musharavati F, Alam T, Alshammari AS, Misran N, Soliman MS, Mahmud S, Khandakar A. Advancement in total hip implant: a comprehensive review of mechanics and performance parameters across diverse novelties. J Mater Chem B 2023; 11:10507-10537. [PMID: 37873807 DOI: 10.1039/d3tb01469j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
The UK's National Joint Registry (NJR) and the American Joint Replacement Registry (AJRR) of 2022 revealed that total hip replacement (THR) is the most common orthopaedic joint procedure. The NJR also noted that 10-20% of hip implants require revision within 1 to 10 years. Most of these revisions are a result of aseptic loosening, dislocation, implant wear, implant fracture, and joint incompatibility, which are all caused by implant geometry disparity. The primary purpose of this review article is to analyze and evaluate the mechanics and performance factors of advancement in hip implants with novel geometries. The existing hip implants can be categorized based on two parts: the hip stem and the joint of the implant. Insufficient stress distribution from implants to the femur can cause stress shielding, bone loss, excessive micromotion, and ultimately, implant aseptic loosening due to inflammation. Researchers are designing hip implants with a porous lattice and functionally graded material (FGM) stems, femur resurfacing, short-stem, and collared stems, all aimed at achieving uniform stress distribution and promoting adequate bone remodeling. Designing hip implants with a porous lattice FGM structure requires maintaining stiffness, strength, isotropy, and bone development potential. Mechanical stability is still an issue with hip implants, femur resurfacing, collared stems, and short stems. Hip implants are being developed with a variety of joint geometries to decrease wear, improve an angular range of motion, and strengthen mechanical stability at the joint interface. Dual mobility and reverse femoral head-liner hip implants reduce the hip joint's dislocation limits. In addition, researchers reveal that femoral headliner joints with unidirectional motion have a lower wear rate than traditional ball-and-socket joints. Based on research findings and gaps, a hypothesis is formulated by the authors proposing a hip implant with a collared stem and porous lattice FGM structure to address stress shielding and micromotion issues. A hypothesis is also formulated by the authors suggesting that the utilization of a spiral or gear-shaped thread with a matched contact point at the tapered joint of a hip implant could be a viable option for reducing wear and enhancing stability. The literature analysis underscores substantial research opportunities in developing a hip implant joint that addresses both dislocation and increased wear rates. Finally, this review explores potential solutions to existing obstacles in developing a better hip implant system.
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Affiliation(s)
- Md Mohiuddin Soliman
- Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohammad Tariqul Islam
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Muhammad E H Chowdhury
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Abdulrahman Alqahtani
- Department of Medical Equipment Technology, College of Applied, Medical Science, Majmaah University, Majmaah City 11952, Saudi Arabia
- Department of Biomedical Technology, College of Applied Medical Sciences in Al-Kharj, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Farayi Musharavati
- Department of Mechanical & Industrial Engineering, Qatar University, Doha 2713, Qatar.
| | - Touhidul Alam
- Pusat Sains Ankasa (ANGKASA), Institut Perubahan Iklim, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Selangor, Malaysia.
| | - Ahmed S Alshammari
- Department of Electrical Engineering, College of Engineering, University Hail, Hail 81481, Saudi Arabia.
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
| | - Norbahiah Misran
- Centre for Advanced Electronic and Communication Engineering, Department of Electrical, Electronic and Systems Engineering, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia (UKM), Bangi 43600, Malaysia.
| | - Mohamed S Soliman
- Department of Electrical Engineering, College of Engineering, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia.
- Department of Electrical Engineering, Faculty of Energy Engineering, Aswan University, Aswan, 81528, Egypt
| | - Sakib Mahmud
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
| | - Amith Khandakar
- Department of Electrical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar.
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Kebbach M, Schulze C, Meyenburg C, Kluess D, Sungu M, Hartmann A, Günther KP, Bader R. Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem replacement regarding impingement-free range of motion? J Orthop Res 2023; 41:2501-2515. [PMID: 37132090 DOI: 10.1002/jor.25584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/14/2023] [Accepted: 05/01/2023] [Indexed: 05/04/2023]
Abstract
Total hip joint replacement (THR) is clinically well-established. In this context, the resulting range of motion (ROM) is crucial for patient satisfaction when performing joint movements. However, the ROM for THR with different bone preserving strategies (short hip stem and hip resurfacing) raises the question of whether the ROM is comparable with conventional hip stems. Therefore, this computer-based study aimed to investigate the ROM and type of impingement for different implant systems. An established framework with computer-aided design 3D models based on magnetic resonance imaging data of 19 patients with hip osteoarthritis was used to analyse the ROM for three different implant systems (conventional hip stem vs. short hip stem vs. hip resurfacing) during typical joint movements. Our results revealed that all three designs led to mean maximum flexion higher than 110°. However, hip resurfacing showed less ROM (-5% against conventional and -6% against short hip stem). No significant differences were observed between the conventional and short hip stem during maximum flexion and internal rotation. Contrarily, a significant difference was detected between the conventional hip stem and hip resurfacing during internal rotation (p = 0.003). The ROM of the hip resurfacing was lower than the conventional and short hip stem during all three movements. Furthermore, hip resurfacing shifted the impingement type to implant-to-bone impingement compared with the other implant designs. The calculated ROMs of the implant systems achieved physiological levels during maximum flexion and internal rotation. However, bone impingement was more likely during internal rotation with increasing bone preservation. Despite the larger head diameter of hip resurfacing, the ROM examined was substantially lower than that of conventional and short hip stem.
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Affiliation(s)
- Maeruan Kebbach
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Schulze
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Christian Meyenburg
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
| | - Mevluet Sungu
- Research and Development, Aesculap AG, Tuttlingen, Germany
| | - Albrecht Hartmann
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Klaus-Peter Günther
- Department of Orthopedic Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Rainer Bader
- Department of Orthopaedics, Rostock University Medical Center, Rostock, Germany
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Andronic O, Germann C, Jud L, Zingg PO. Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia. Bone Joint J 2023; 105-B:735-742. [PMID: 37391200 DOI: 10.1302/0301-620x.105b7.bjj-2022-1058.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Aims This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD. Methods We identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology. Results The mean follow-up was 96 months (67 to 139). The SHV, mHHS, WOMAC, and Tegner scores significantly improved (p < 0.001) at last follow-up. According to SHV and mHHS, there were three hips (7%) with poor results (SHV < 70), three (7%) with a fair score (70 to 79), eight (19%) with good results (80 to 89), and 28 (67%) who scored excellent (> 90) at the last follow-up. There were 11 subsequent operations: nine implant removals due to local irritation, one resection of postoperative heterotopic ossification, and one hip arthroscopy for intra-articular adhesions. No hips were converted to total hip arthroplasty at last follow-up. The presence of preoperative labral lesions or LT lesions did not influence any PROMs at last follow-up. From the three hips that had poor PROMs, two have developed severe osteoarthritis (> Tönnis II), presumably due to surgical overcorrection (postoperative AI < -10°). Conclusion PAO is reliable in treating BHD with favourable mid-term outcomes. Concomitant LT and labral lesions did not negatively influence outcomes in our cohort. Technical accuracy with avoidance of overcorrection is essential in achieving successful outcomes.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Shoji T, Inoue T, Kato Y, Fujiwara Y, Sumii J, Shozen H, Adachi N. Associations between implant alignment or position and patient-reported outcomes after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2022; 97:105701. [PMID: 35696828 DOI: 10.1016/j.clinbiomech.2022.105701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aimed to evaluate the associations between implant alignment/position and patient-reported outcomes following total hip arthroplasty using CT-based simulation software. METHODS We reviewed hips of 137 patients (27 males, 110 females, mean age: 67.3 years old) who underwent total hip arthroplasty. Radiographic evaluations were based on the software for evaluation of the parameters related to implant alignment/position and femoral/3-dimensional offset using post-operative CT data. Pre-operative and one-year post-operative patient-reported outcomes using Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire scores were evaluated. FINDINGS The total and movement scores of normal combined anteversion and stem anteversion angle groups were significantly higher than those of lower and higher groups. The pain and movement scores of decreased femoral offset group were significantly lower than those of restored and increased femoral offset group. There were no significant differences in all scores in cup inclination and anteversion angle, stem coronal alignment, and 3-dimensional femoral offset among groups. Moreover, investigation of the associations between combined anteversion angle/stem anteversion/femoral offset and movement scores revealed that combined anteversion angle and stem anteversion were significantly associated with the movement that needs deep hip flexion and occasionally deep abduction, and high femoral offset was also associated with the movement that needs deep hip flexion. INTERPRETATION Surgeons should consider the stem anteversion, stem sagittal alignment, and combined anteversion, in addition to the femoral offset to achieve patient's post-operative satisfaction, although the surgeon may have a relatively larger choice for the implant positioning, especially on the cup side.
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Affiliation(s)
- Takeshi Shoji
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan; Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Junichi Sumii
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Shozen
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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7
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Tsukamoto M, Kawasaki M, Suzuki H, Fujitani T, Uchida S, Sakai A. Accurate cup placement using a portable navigation system during total hip arthroplasty based on pelvic orientation in the lateral decubitus position. Artif Organs 2022; 46:2412-2422. [PMID: 35524678 DOI: 10.1111/aor.14281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/17/2022] [Accepted: 04/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND We previously proposed an accurate cup placement procedure using a portable navigation system (PNS) for total hip arthroplasty (THA) in the lateral decubitus position; however, as the accuracy of our proposed procedure has not been shown, the aim of this study was to demonstrate the accuracy. METHODS We prospectively analyzed 79 hips treated with primary THA; 40 hips treated until June 2020 were included in the conventional procedure (CP) group, and 39 hips treated from July 2020 were included in the modified procedure (MP) group. In the MP, pelvic orientation is considered to the set coordinate axes in addition to the CP using the PNS. The accuracy was based on the difference between the navigation record (NR) and postoperative computed tomography measurement. RESULTS The radiographic inclination (RI) and anteversion (RA) accuracies were 1.55° and 2.14°, respectively, in the MP group and 3.03° and 6.20°, respectively, in the CP group (p < 0.001). The error was within 5° of the NR for both the RI and RA in 34 in the MP group (87.2%) and 14 in the CP group (35.0%) (p < 0.001). The error was within 5° of the target angle (RI 40°, RA 15°) for both the RI and RA in 29 hips in the MP group (74.7%) and 12 in the CP group (30.0%) (p < 0.001). CONCLUSIONS Our procedure with the consideration of pelvic orientation achieved dramatically improved the accuracy of PNS and was suitable to facilitate accurate cup placement.
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Affiliation(s)
- Manabu Tsukamoto
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Makoto Kawasaki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Hitoshi Suzuki
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Teruaki Fujitani
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
| | - Soshi Uchida
- Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Japan
| | - Akinori Sakai
- Department of Orthopaedic Surgery, School of Medicine, University of Occupational and Environmental Health, Japan
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Pryce GM, Sabu B, Al-Hajjar M, Wilcox RK, Thompson J, Isaac GH, Board T, Williams S. Impingement in total hip arthroplasty: A geometric model. Proc Inst Mech Eng H 2022; 236:9544119211069472. [PMID: 35147063 PMCID: PMC8915222 DOI: 10.1177/09544119211069472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
Total Hip Arthroplasty (THA) is one of the most common and successful surgical interventions. The survivorship at 10 years for the most commonly used systems is over 95%. However, the incidence of revision is usually much higher in the 0-1 year time period following the intervention. The most common reason for revision in this early time period is dislocation and subluxation, which may be defined as complete or permanent, and partial or temporary loss of contact between the bearing surfaces respectively. This study comprises the development of a geometric model of bone and an in situ total hip replacement, to predict the occurrence and location of bone and component impingement for a wide range of acetabular cup positions and for a series of frequently practiced activities of daily living. The model developed predicts that anterior-superior component impingement is associated with activities that result in posterior dislocation. The incidence may be reduced by increased cup anteversion and inclination. Posterior-inferior component impingement is associated with anterior dislocation activities. Its incidence may be reduced by decreased cup anteversion and inclination. A component impingement-free range was identified, running from when the cup was positioned with 45° inclination and 25° anteversion to 70° inclination and 15°-20° anteversion.
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Affiliation(s)
- Gregory M Pryce
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Bismaya Sabu
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Mazen Al-Hajjar
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
- DePuy Synthes Joint Reconstruction, Leeds, UK
| | - Ruth K Wilcox
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Jonathan Thompson
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
- DePuy Synthes Joint Reconstruction, Leeds, UK
| | - Graham H Isaac
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Tim Board
- Wrightington Wigan and Leigh NHS Trust, Wigan, UK
| | - Sophie Williams
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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9
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Solórzano-Requejo W, Ojeda C, Díaz Lantada A. Innovative Design Methodology for Patient-Specific Short Femoral Stems. MATERIALS 2022; 15:ma15020442. [PMID: 35057160 PMCID: PMC8778668 DOI: 10.3390/ma15020442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/01/2022] [Accepted: 01/04/2022] [Indexed: 12/18/2022]
Abstract
The biomechanical performance of hip prostheses is often suboptimal, which leads to problems such as strain shielding, bone resorption and implant loosening, affecting the long-term viability of these implants for articular repair. Different studies have highlighted the interest of short stems for preserving bone stock and minimizing shielding, hence providing an alternative to conventional hip prostheses with long stems. Such short stems are especially valuable for younger patients, as they may require additional surgical interventions and replacements in the future, for which the preservation of bone stock is fundamental. Arguably, enhanced results may be achieved by combining the benefits of short stems with the possibilities of personalization, which are now empowered by a wise combination of medical images, computer-aided design and engineering resources and automated manufacturing tools. In this study, an innovative design methodology for custom-made short femoral stems is presented. The design process is enhanced through a novel app employing elliptical adjustment for the quasi-automated CAD modeling of personalized short femoral stems. The proposed methodology is validated by completely developing two personalized short femoral stems, which are evaluated by combining in silico studies (finite element method (FEM) simulations), for quantifying their biomechanical performance, and rapid prototyping, for evaluating implantability.
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Affiliation(s)
- William Solórzano-Requejo
- Product Development Laboratory, Department of Mechanical Engineering, Universidad Politécnica de Madrid, C/José Gutiérrez Abascal 2, 28006 Madrid, Spain
- Mechanical Technology Laboratory, Department of Mechanical and Electrical Engineering, Universidad de Piura, Piura 20009, Peru; or
- Correspondence: or (W.S.-R.); (A.D.L.)
| | - Carlos Ojeda
- Mechanical Technology Laboratory, Department of Mechanical and Electrical Engineering, Universidad de Piura, Piura 20009, Peru; or
| | - Andrés Díaz Lantada
- Product Development Laboratory, Department of Mechanical Engineering, Universidad Politécnica de Madrid, C/José Gutiérrez Abascal 2, 28006 Madrid, Spain
- Correspondence: or (W.S.-R.); (A.D.L.)
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Shoji T, Ota Y, Saka H, Murakami H, Takahashi W, Yamasaki T, Yasunaga Y, Iwamori H, Adachi N. Factors affecting impingement and dislocation after total hip arthroplasty - Computer simulation analysis. Clin Biomech (Bristol, Avon) 2020; 80:105151. [PMID: 32836081 DOI: 10.1016/j.clinbiomech.2020.105151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Studies on the causes and factors affecting dislocation after total hip arthroplasty have revealed conflicting results. The purpose of this study was to evaluate the factors affecting impingement and dislocation after total hip arthroplasty, using a 3-dimensional dynamic motion analysis. METHODS The CT data of 53 patients (53 hips: anterior dislocation; 11 cases, and posterior dislocation; 42 cases) who experienced hip dislocation after total hip arthroplasty with posterior approach, and 120 control patients (120 hips) without dislocation were analyzed. Parameters related to implant alignment, offset and leg length were evaluated. The impingement type was also analyzed using a software. FINDINGS Considering implant settings affecting dislocation, patients at risk for posterior dislocation had decreased stem anteversion, combined anteversion, femoral offset, and leg length. Nevertheless, patients at risk for anterior dislocation had only lower leg length, and these patients may also be at risk for a higher incidence of recurrent dislocation. Bony impingement occurred in almost half of the cases with posterior dislocation, while implant impingement was associated with anterior dislocation. Importantly, anterior dislocation was not as common as posterior dislocation even in cases with occurrence of posterior impingement. INTERPRETATION Bony impingement substantially affects dislocation even in the situation where the implant position and alignment are determined by the so-called "safe zone", especially on the anterior side, while implant impingement affects anterior dislocation. The restoration of anterior offset (i.e., prescribed by the stem anteversion and femoral offset) and combined anteversion is critical for avoidance of posterior dislocation after total hip arthroplasty.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Yuki Ota
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiroaki Murakami
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Wakan Takahashi
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Kure Medical Center and Chugoku Cancer Center, 3-1 Aoyama town, Kure city, Hiroshima 737-0023, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Hiroshi Iwamori
- Department of Orthopaedic Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-ku, Hiroshima 730-8562, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Tagomori H, Kaku N, Tabata T, Kubota Y, Tsumura H. Comparison of cementless and cemented cups in revision total hip arthroplasty using a computed tomography-based navigation system. J Clin Orthop Trauma 2020; 11:S206-S210. [PMID: 32189941 PMCID: PMC7067992 DOI: 10.1016/j.jcot.2019.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Studies comparing cementless and cemented cups are lacking, especially for revision total hip arthroplasty (THA). The aim of this study was to investigate and compare the differences in implant accuracy between two fixation methods in revision THA. METHODS We conducted a retrospective study of 85 hips in 70 patients who underwent revision THA using a computed tomography (CT)-based navigation system. Among these, 53 hips underwent cementless THA and 32 hips underwent cemented THA. We measured cup inclination and anteversion using the Kyocera two-dimensional-template with X-ray (Japan-Kyocera, Shiga, Japan) and stem anteversion with CT. We calculated the combined anteversion [cup anteversion+0.7×stem anteversion]. RESULTS There were no significant differences between the two groups with respect to definitive cup inclination and anteversion. The mean deviations in the inclination and anteversion angle were 40.3 ± 4.3 and 19.6 ± 6.2° in the cementless group and 40.5 ± 3.3 and 17.1 ± 5.1° in the cemented group. There were 11 outliers with respect to the Lewinnek safe zone in the cementless group and two in the cemented group (P = 0.072). Although there was no statistically significant difference, the number of safe zone outliers in the cemented group was less than that in the cementless group. CONCLUSION We conclude that when using a navigation system for revision THA, high precision can be obtained for the cup placement angle with or without cement. However, it seems that a major error in the installation angle of the cup is less likely to occur when using a cemented cup than when using a cementless cup in revision THA with a navigation system.
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Affiliation(s)
| | - Nobuhiro Kaku
- Corresponding author. Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi Yufu city, Oita, 879-5593, Japan.
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Shoji T, Yamasaki T, Izumi S, Kenji M, Sawa M, Yasunaga Y, Adachi N. The effect of cup medialization and lateralization on hip range of motion in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 57:121-128. [PMID: 29986274 DOI: 10.1016/j.clinbiomech.2018.06.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is little description of the effect of cup position on the hip range of motion in total hip arthroplasty. The purpose is to evaluate the effect of cup medialization/lateralization with a compensatory increase/decrease in femoral offset on the hip range of motion, and whether the bone morphology of the anterior inferior iliac spine affects hip range of motion in total hip arthroplasty. METHODS Using the CT data of 100 patients (male; 30, female; 70), 3D-dynamic motion analysis was performed in four scenarios with cup medialization/lateralization with the same/decreased global offset. We calculated the range of motion before component impingement and bony impingement in flexion, internal rotation and external rotation using the software. Furthermore, we measured bony morphological features of anterior inferior iliac spine, and we analyzed the correlations among them. FINDINGS We found that the cup medialization with the same stem offset had negative effects on hip range of motion in flexion and internal rotation due to bony impingement, whereas cup medialization caused external rotation to significantly decrease with the same global offset. On the other hand, cup lateralization with the same global offset had negative effects on flexion and internal rotation, whereas external rotation increased. Furthermore, there were negative correlations among flexion and laterally large and steep anterior inferior iliac spine. INTERPRETATION Our results demonstrated that the advantage of cup medialization can depend on the individual anatomy such as bony morphology of anterior inferior iliac spine in flexion.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Soutarou Izumi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mifuji Kenji
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Mikiya Sawa
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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13
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Geometric analysis and clinical outcome of two cemented stems for primary total hip replacement with and without modular necks. Arch Orthop Trauma Surg 2017; 137:1571-1578. [PMID: 28916885 DOI: 10.1007/s00402-017-2785-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Restoration of the physiological biomechanical principles of the hip is crucial in total hip replacement. The aim of this study was to compare an arthroplasty system with different offset options (a: Exeter®) with a dual-modular stem (b: Profemur Xm®). MATERIALS AND METHODS A local and an inertial coordinate system were used to assist the description of the components' assembly in the prosthesis. A resection line of the femoral head in standard position was added to the arthroplasties and geometric parameters were measured. The outcomes of 93 patients were clinically evaluated (a: n = 50, b: n = 43). Preoperative planning was compared to postoperative radiographs (femoral offset, leg-length), and clinical scores (HHS, WOMAC, total range of motion) were assessed preoperatively, and then 1 and 2 years after surgery. RESULTS The Exeter® offers an offset range from 32.1 to 56.9 mm and the Profemur Xm® a range from 29.3 to 55.3 mm. The leg-length variability of the Profemur Xm® has a range of 25.9 mm, the Exeter® a range of 13.7 mm. The Profemur Xm® offers more possible combinations of offset and leg-length reconstruction. The neck-stem angles of the Exeter® range from 125.2° to 126.3°, of the Profemur Xm® from 127.2° to 142.6°. There was no statistically significant difference in clinical outcome and radiological parameters. CONCLUSIONS We conclude that both stems offer a wide range of options for anatomical reconstruction of the hip resulting in similarly good clinical results. The Profemur Xm® stem has advantages for the reconstruction of hips that deviate from standard anatomy but has the drawback of additional corrosive wear at the stem/neck interface.
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14
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Geier A, Kluess D, Grawe R, Herrmann S, D'Lima D, Woernle C, Bader R. Dynamical analysis of dislocation-associated factors in total hip replacements by hardware-in-the-loop simulation. J Orthop Res 2017; 35:2557-2566. [PMID: 28233341 DOI: 10.1002/jor.23549] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/16/2017] [Indexed: 02/04/2023]
Abstract
Since dislocation of total hip replacements (THR) remains a clinical problem, its mechanisms are still in the focus of research. Previous studies ignored the impact of soft tissue structures and dynamic processes or relied on simplified joint contact mechanics, thus, hindered a thorough understanding. Therefore, the purpose of the present study was to use hardware-in-the-loop (HiL) simulation to analyze systematically the impact of varying implant positions and designs as well as gluteal and posterior muscle function on THR instability under physiological-like loading conditions during dynamic movements. A musculoskeletal multibody model emulated the in situ environment of the lower extremity during deep sit-to-stand with femoral adduction maneuver while a six-axis robot moved and loaded a THR accordingly to feed physical measurements back to the multibody model. Commercial THRs with hard-soft bearings were used in the simulation with three different head diameters (28, 36, 44 mm) and two offsets (M, XL). Cup inclination of 45°, cup anteversion of 20°, and stem anteversion of 10° revealed to be outstandingly robust against any instability-related parameter variation. For the flexion motion, higher combined anteversion angles of cup and stem seemed generally favorable. Total hip instability was either deferred or even avoided even in the presence of higher cup inclination. Larger head diameters (>36 mm) and femoral head offsets (8 mm) deferred occurrence of prosthetic and bone impingement associated with increasing resisting torques. In summary, implant positioning had a much higher impact on total hip stability than gluteal insufficiency and impaired muscle function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2557-2566, 2017.
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Affiliation(s)
- Andreas Geier
- Department of Orthopaedics, University Medicine of Rostock, Doberaner Straße 142, D-18057 Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, University Medicine of Rostock, Doberaner Straße 142, D-18057 Rostock, Germany
| | - Robert Grawe
- Chair of Technical Dynamics, University of Rostock, Rostock, Germany
| | - Sven Herrmann
- Department of Orthopaedics, University Medicine of Rostock, Doberaner Straße 142, D-18057 Rostock, Germany
| | - Darryl D'Lima
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, California
| | - Christoph Woernle
- Chair of Technical Dynamics, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine of Rostock, Doberaner Straße 142, D-18057 Rostock, Germany
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15
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Loppini M, Longo UG, Caldarella E, Rocca AD, Denaro V, Grappiolo G. Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty. BMC Musculoskelet Disord 2017; 18:331. [PMID: 28764697 PMCID: PMC5539744 DOI: 10.1186/s12891-017-1688-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 07/24/2017] [Indexed: 11/17/2022] Open
Abstract
Background The relevance of prosthetic component orientation to prevent dislocation and impingement following total hip arthroplasty (THA) has been widely accepted. We investigated the use of a non-computer-based surgery to address the reciprocal orientation of the acetabular and femoral components. Methods In the femur first technique, the cup is positioned relative to the stem. When the definitive antetorsion of femoral component is fixed, the cup is positioned in a compliant anteversion to the stem. Clinical and radiographic assessments were performed before and 3 months after THA. Radiographic assessment was performed in standing position with the EOS 2D/3D radiography system. 3D images were used to preoperative anterior pelvic plane (APP) angle, postoperative acetabular inclination (AI) and anteversion (AA), and postoperative stem antetorsion. Clinical assessment was performed with Harris Hip Score (HHS). Results Forty patients (40 hips) underwent primary THA with an average age of 61 years (range, 36–84). Average HHS increased from 43 ± 5 (range, 37–52) preoperatively to 97 ± 6 (range, 86–100) at the last follow-up (P < 0.0001). Average combined anteversion value of cup with liner and stem was 38° ± 9° (range, 12°-55°). Average AI value of cup with liner was 39° ± 6° (range, 30°-55°) in the group with standard stem and 45° ± 7° (range, 39°-58°) in the group with varized stem (P = 0.007). Relationship analysis showed no correlation between the combined anteversion values of the cup with liner and stem with APP angle values (r = 0.26, P = 0.87). Conclusions Femur first technique allows the surgeon to achieve a combined anteversion ranging from 25° to 50° with a cup inclination ranging from 30° to 50°. The cup is positioned according to the functional plane of the patient regardless the preoperative pelvic tilt.
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Affiliation(s)
- Mattia Loppini
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. .,Humanitas University, Via Alessandro Manzoni 113, 20089, Rozzano, Milan, Italy.
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Emanuele Caldarella
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Antonello Della Rocca
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128, Trigoria, Rome, Italy
| | - Guido Grappiolo
- Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Centre, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
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16
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Snijders T, van Gaalen S, de Gast A. Precision and accuracy of imageless navigation versus freehand implantation of total hip arthroplasty: A systematic review and meta-analysis. Int J Med Robot 2017; 13. [DOI: 10.1002/rcs.1843] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 03/27/2017] [Accepted: 04/24/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Thom Snijders
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
- Diakonessenhuis Utrecht Zeist Doorn - Locatie Zeist; Zeist 3700 BA Netherlands
| | - S.M. van Gaalen
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
| | - A. de Gast
- Clinical Orthopedic Research Center - mN, Orthopedics; Zeist 3707 HL Netherlands
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17
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Herrmann S, Kluess D, Kaehler M, Grawe R, Rachholz R, Souffrant R, Zierath J, Bader R, Woernle C. A Novel Approach for Dynamic Testing of Total Hip Dislocation under Physiological Conditions. PLoS One 2015; 10:e0145798. [PMID: 26717236 PMCID: PMC4696831 DOI: 10.1371/journal.pone.0145798] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 12/08/2015] [Indexed: 12/27/2022] Open
Abstract
Constant high rates of dislocation-related complications of total hip replacements (THRs) show that contributing factors like implant position and design, soft tissue condition and dynamics of physiological motions have not yet been fully understood. As in vivo measurements of excessive motions are not possible due to ethical objections, a comprehensive approach is proposed which is capable of testing THR stability under dynamic, reproducible and physiological conditions. The approach is based on a hardware-in-the-loop (HiL) simulation where a robotic physical setup interacts with a computational musculoskeletal model based on inverse dynamics. A major objective of this work was the validation of the HiL test system against in vivo data derived from patients with instrumented THRs. Moreover, the impact of certain test conditions, such as joint lubrication, implant position, load level in terms of body mass and removal of muscle structures, was evaluated within several HiL simulations. The outcomes for a normal sitting down and standing up maneuver revealed good agreement in trend and magnitude compared with in vivo measured hip joint forces. For a deep maneuver with femoral adduction, lubrication was shown to cause less friction torques than under dry conditions. Similarly, it could be demonstrated that less cup anteversion and inclination lead to earlier impingement in flexion motion including pelvic tilt for selected combinations of cup and stem positions. Reducing body mass did not influence impingement-free range of motion and dislocation behavior; however, higher resisting torques were observed under higher loads. Muscle removal emulating a posterior surgical approach indicated alterations in THR loading and the instability process in contrast to a reference case with intact musculature. Based on the presented data, it can be concluded that the HiL test system is able to reproduce comparable joint dynamics as present in THR patients.
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Affiliation(s)
- Sven Herrmann
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Daniel Kluess
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Michael Kaehler
- Chair of Technical Dynamics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
| | - Robert Grawe
- Chair of Technical Dynamics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
| | - Roman Rachholz
- Chair of Technical Dynamics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
| | - Robert Souffrant
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - János Zierath
- Chair of Technical Dynamics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine Rostock, Rostock, Germany
| | - Christoph Woernle
- Chair of Technical Dynamics, Faculty of Mechanical Engineering and Marine Technology, University of Rostock, Rostock, Germany
- * E-mail:
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Serum Metal Ions with a Titanium Modular Neck Total Hip Replacement System. J Arthroplasty 2015; 30:1781-6. [PMID: 26027522 DOI: 10.1016/j.arth.2015.04.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 02/01/2023] Open
Abstract
The goal of this study is to evaluate serum levels of chromium (Cr), cobalt (Co), and titanium (Ti) within the first two years following total hip arthroplasty using a Ti modular neck system. Twenty-five patients were randomized to a metal-on-metal (MoM) bearing with an all CoCr shell, and the remaining 25 received a metal-on-polyethylene (MoP) with a Ti shell. Serum levels demonstrated increases for Cr, Co, and Ti at 1 year (P < .001). MoM had similar Ti levels to MoP hips at 1 year (P=0.11) but lower at 2 years (P=0.03). Results suggest that the passive corrosion (i.e., chemical, pitting, and crevice corrosion) of exposed non-articular metal surfaces may be a greater source of ions than the neck-stem or head-neck interfaces.
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19
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Innmann MM, Streit MR, Kolb J, Heiland J, Parsch D, Aldinger PR, Königshausen M, Gotterbarm T, Merle C. Influence of surgical approach on component positioning in primary total hip arthroplasty. BMC Musculoskelet Disord 2015; 16:180. [PMID: 26242180 PMCID: PMC4523950 DOI: 10.1186/s12891-015-0623-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background Minimal invasive surgery (MIS) has gained growing popularity in total hip arthroplasty (THA) but concerns exist regarding component malpositioning. The aim of the present study was to evaluate femoral and acetabular component positioning in primary cementless THA comparing a lateral to a MIS anterolateral approach. Methods We evaluated 6 week postoperative radiographs of 52 hips with a minimal invasive anterolateral approach compared to 54 hips with a standard lateral approach. All hips had received the same type of implant for primary cementless unilateral THA and had a healthy hip contralaterally. Results Hip offset was equally restored comparing both approaches. No influence of the approach was observed with regard to reconstruction of acetabular offset, femoral offset, vertical placement of the center of rotation, stem alignment and leg length discrepancy. However, with the MIS approach, a significantly higher percentage of cups (38.5 %) was malpositioned compared to the standard approach (16.7 %) (p = 0.022). Conclusions The MIS anterolateral approach allows for comparable reconstruction of stem position, offset and center of rotation compared to the lateral approach. However, surgeons must be aware of a higher risk of cup malpositioning for inclination and anteversion using the MIS anterolateral approach.
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Affiliation(s)
- Moritz M Innmann
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Marcus R Streit
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jeanette Kolb
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Jochen Heiland
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Dominik Parsch
- Department of Orthopaedic and Trauma Surgery, Karl-Olga-Krankenhaus, Hackstraße 61, 70190, Stuttgart, Germany.
| | - Peter R Aldinger
- Department of Orthopaedic and Trauma Surgery, Paulinenhilfe, Diakonieklinikum, Rosenbergstrasse 38, 70192, Stuttgart, Germany.
| | - Matthias Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Tobias Gotterbarm
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
| | - Christian Merle
- Department of Orthopaedic and Trauma Surgery, University of Heidelberg, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
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20
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The sagittal stem alignment and the stem version clearly influence the impingement-free range of motion in total hip arthroplasty: a computer model-based analysis. INTERNATIONAL ORTHOPAEDICS 2015; 40:473-80. [DOI: 10.1007/s00264-015-2845-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/09/2015] [Indexed: 10/23/2022]
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21
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Effect of femoral neck modularity upon the prosthetic range of motion in total hip arthroplasty. Med Biol Eng Comput 2014; 52:685-94. [PMID: 24969948 PMCID: PMC4102828 DOI: 10.1007/s11517-014-1171-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 06/17/2014] [Indexed: 11/09/2022]
Abstract
In total hip arthroplasty, aseptic loosening and dislocation are associated with not being able to achieve the correct prosthetic component orientation. Femoral neck modularity has been proposed as a solution to this problem by allowing the surgeon to alter either the neck-shaft or version angle of the prosthetic femoral component intra-operatively. A single replicate full factorial design was used to evaluate how effective a modular femoral neck cementless stem was in restoring a healthy prosthetic range of motion in comparison with a leading fixed-neck cementless stem with the standard modular parameters. It was found that, if altered to a large enough degree, femoral neck modularity can increase the amount of prosthetic motion as well as alter its position to where it is required physiologically. However, there is a functional limit to the amount that can be corrected and there is a risk with regard to the surgeon having to select the optimum modular neck before any benefit is realised.
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Morphological study of the newly designed cementless femoral stem. BIOMED RESEARCH INTERNATIONAL 2014; 2014:692328. [PMID: 25025068 PMCID: PMC4082868 DOI: 10.1155/2014/692328] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 04/11/2014] [Accepted: 04/13/2014] [Indexed: 11/30/2022]
Abstract
A morphology study was essential to the development of the cementless femoral stem because accurate dimensions for both the periosteal and endosteal canal ensure primary fixation stability for the stem, bone interface, and prevent stress shielding at the calcar region. This paper focused on a three-dimensional femoral model for Asian patients that applied preoperative planning and femoral stem design. We measured various femoral parameters such as the femoral head offset, collodiaphyseal angle, bowing angle, anteversion, and medullary canal diameters from the osteotomy level to 150 mm below the osteotomy level to determine the position of the isthmus. Other indices and ratios for the endosteal canal, metaphyseal, and flares were computed and examined. The results showed that Asian femurs are smaller than Western femurs, except in the metaphyseal region. The canal flare index (CFI) was poorly correlated (r < 0.50) to the metaphyseal canal flare index (MCFI), but correlated well (r = 0.66) with the corticomedullary index (CMI). The diversity of the femoral size, particularly in the metaphyseal region, allows for proper femoral stem design for Asian patients, improves osseointegration, and prolongs the life of the implant.
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Miki H, Kyo T, Kuroda Y, Nakahara I, Sugano N. Risk of edge-loading and prosthesis impingement due to posterior pelvic tilting after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2014; 29:607-13. [PMID: 24933660 DOI: 10.1016/j.clinbiomech.2014.05.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/09/2014] [Accepted: 05/12/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proper implant orientation is essential for avoiding edge-loading and prosthesis impingement in total hip arthroplasty. Although cup orientation is affected by a change in pelvic tilt after surgery, it has been unclear whether surgeons can prevent impingement and edge-loading by proper positioning by taking into account any change in pelvic alignment associated with alteration of hip range of motion. METHODS We simulated implant orientation without edge-loading and prosthesis impingement, even with a change in pelvic tilt and associated change in hip range of motion after surgery, by collision detection using implant models created with computer-aided design. FINDINGS If posterior pelvic tilting with a corresponding hyperextension change in hip range of motion after surgery remains within 10°, as occurs in 90% of cases, surgeons can avoid edge-loading and impingement by correctly orienting the implant, even when using a conventional prosthesis. However, if a 20° change occurs after surgery, it may be difficult to avoid those risks. INTERPRETATION Although edge-loading and impingement can be prevented by performing appropriate surgery in most cases, even when taking into account postoperative changes in pelvic tilt, it may also be important to pay attention to spinal conditions to ensure that pelvic tilting is not extreme because of increasing kyphosis.
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Affiliation(s)
- Hidenobu Miki
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Takayuki Kyo
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Yasuo Kuroda
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Ichiro Nakahara
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
| | - Nobuhiko Sugano
- Department of Orthopedic Surgery, Medical School of Osaka University, Osaka, Japan.
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Ezzet KA, McCauley JC. Use of intraoperative X-rays to optimize component position and leg length during total hip arthroplasty. J Arthroplasty 2014; 29:580-5. [PMID: 24074889 DOI: 10.1016/j.arth.2013.08.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/05/2013] [Indexed: 02/01/2023] Open
Abstract
Proper femoral and acetabular component position and leg length equality are important intraoperative considerations during total hip arthroplasty. Unfortunately, traditional surgical techniques often lead to suboptimal component position, and such deviations have been associated with increased rates of prosthetic wear, dislocation, component loosening, and patient dissatisfaction. Although surgical navigation has been shown to improve reproducibility of component alignment, such technology is not universally available and is associated with significant costs and additional surgical/anesthetic time. In the current study, we found that a routine intraoperative pelvic radiograph could successfully identify malpositioned components and leg length inequalities and could allow for successful correction of identified problems. Unexpected component malposition and leg length inequality occurred in only 1.5% of cases where an intraoperative pelvic radiograph was utilized.
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Affiliation(s)
- Kace A Ezzet
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla California.
| | - Julie C McCauley
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, Scripps Health, La Jolla, California
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Design process of cementless femoral stem using a nonlinear three dimensional finite element analysis. BMC Musculoskelet Disord 2014; 15:30. [PMID: 24484753 PMCID: PMC3924227 DOI: 10.1186/1471-2474-15-30] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Accepted: 01/29/2014] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Minimal available information concerning hip morphology is the motivation for several researchers to study the difference between Asian and Western populations. Current use of a universal hip stem of variable size is not the best option for all femur types. This present study proposed a new design process of the cementless femoral stem using a three dimensional model which provided more information and accurate analysis compared to conventional methods. METHODS This complete design cycle began with morphological analysis, followed by femoral stem design, fit and fill analysis, and nonlinear finite element analysis (FEA). Various femur parameters for periosteal and endosteal canal diameters are measured from the osteotomy level to 150 mm below to determine the isthmus position. RESULTS The results showed better total fit (53.7%) and fill (76.7%) canal, with more load distributed proximally to prevent stress shielding at calcar region. The stem demonstrated lower displacement and micromotion (less than 40 μm) promoting osseointegration between the stem-bone and providing primary fixation stability. CONCLUSION This new design process could be used as a preclinical assessment tool and will shorten the design cycle by identifying the major steps which must be taken while designing the femoral stem.
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26
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Zhou H, Wang CT, Ji WT, Zeng XS, Fang S, Wang DM. Motion performance and impingement risk of total hip arthroplasty with a simulation module. J Zhejiang Univ Sci B 2013; 14:849-54. [DOI: 10.1631/jzus.b1200168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Jauch SY, Huber G, Sellenschloh K, Haschke H, Baxmann M, Grupp TM, Morlock MM. Micromotions at the taper interface between stem and neck adapter of a bimodular hip prosthesis during activities of daily living. J Orthop Res 2013; 31:1165-71. [PMID: 23553890 DOI: 10.1002/jor.22354] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Accepted: 03/05/2013] [Indexed: 02/04/2023]
Abstract
The stem-neck taper interface of bimodular hip endoprostheses bears the risk of micromotions that can result in ongoing corrosion due to removal of the passive layer and ultimately cause implant fracture. We investigated the extent of micromotions at the stem-neck interface and the seating behavior of necks of one design made from different alloys during daily activities. Modular hip prostheses (n = 36, Metha®, Aesculap AG, Germany) with neck adapters (CoCr29Mo6 or Ti6Al4V) were embedded in PMMA (ISO 7206-4) and exposed to cyclic loading with peak loads ranging from walking (Fmax = 2.3 kN) to stumbling (Fmax = 5.3 kN). Translational and rotational micromotions at the taper interface and seating characteristics during assembly and loading were determined using four eddy-current sensors. Seating during loading after implant assembly was dependent on load magnitude but not on material coupling. Micromotions in the stem-neck interface correlated positively with load levels (CoCr: 2.6-6.3 µm, Ti: 4.6-13.8 µm; p < 0.001) with Ti neck adapters exhibiting significantly larger micromotions than CoCr (p < 0.001). These findings explain why high body weights and activities related to higher loads could increase the risk of fretting-induced implant failures in clinical application, especially for Ti-Ti combinations. Still, the role of taper seating is not clearly understood.
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Affiliation(s)
- Sabrina Yvonne Jauch
- Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestr. 15, 21073, Hamburg, Germany.
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28
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Weber AE, Skendzel JG, Waxman DL, Blaha JD. Symptomatic Aseptic Hydrogen Pneumarthrosis as a Sign of Crevice Corrosion Following Total Hip Arthroplasty with a Modular Neck: A Case Report. JBJS Case Connect 2013; 3:e76. [PMID: 29252615 DOI: 10.2106/jbjs.cc.l.00261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, SPC 5328, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
| | - Jack G Skendzel
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, SPC 5328, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
| | - David L Waxman
- West Virginia Hip and Knee Replacement Center, 527 Medical Park Drive, Bridgeport, West Virginia 26330
| | - John D Blaha
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, SPC 5328, 1500 East Medical Center Drive, Ann Arbor, MI 48109.
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Colbrunn RW, Bottros JJ, Butler RS, Klika AK, Bonner TF, Greeson C, van den Bogert AJ, Barsoum WK. Impingement and stability of total hip arthroplasty versus femoral head resurfacing using a cadaveric robotics model. J Orthop Res 2013; 31:1108-15. [PMID: 23494830 DOI: 10.1002/jor.22342] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 02/08/2013] [Indexed: 02/04/2023]
Abstract
We identified and compared the impingent-free range of motion (ROM) and subluxation potential for native hip, femoral head resurfacing (FHR), and total hip arthroplasty (THA). These constructs were also compared both with and without soft tissue to elucidate the role of the soft tissue. Five fresh-frozen bilateral hip specimens were mounted to a six-degree of freedom robotic manipulator. Under load-control parameters, in vivo mechanics were recreated to evaluate impingement free ROM, and the subluxation potential in two "at risk" positions for native hip, FHR, and THA. Impingement-free ROM of the skeletonized THA was greater than FHR for the anterior subluxation position. For skeletonized posterior subluxations, stability for THA and FHR constructs were similar, while a different pattern was observed for specimens with soft tissues intact. FHR constructs were more stable than THA constructs for both anterior and posterior subluxations. When the femoral neck is intact the joint has an earlier impingement profile placing the hip at risk for subluxation. However, FHR design was shown to be more stable than THA only when soft tissues were intact.
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Affiliation(s)
- R W Colbrunn
- Cleveland Clinic Foundation, 9500 Euclid Ave Desk A41 Crile Building, Cleveland, OH 44195, USA
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30
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Abstract
In total hip arthroplasty, steep cup inclination should be avoided because it increases the risk of edge loading. Pelvic posterior tilt should be carefully monitored because it increases cup inclination and anteversion, leading to edge loading or impingement. The authors evaluated how much the pelvic tilt angle changes from the supine position referenced in planning for cup orientation preoperatively to the standing position 1 year after total hip arthroplasty (Δref). The pelvic tilt angle was measured in 124 patients who underwent total hip arthroplasty due to osteoarthritis, and the mean Δref was -9.5°±5.3° (range, -23° to 5°). Preoperative compression fractures, spondylolisthesis, and disk-space narrowing were predictive of increased pelvic posterior tilt after total hip arthroplasty. The authors mathematically calculated how much change in pelvic posterior tilt was clinically possible with the original cup alignment, which ranged from 40° to 45° of radiographic inclination and 0° to 30° radiographic anteversion to more than 50° of inclination. Even if the maximum posterior tilt (23°) occurred, no edge loading would occur in almost half of those original cups. Surgeons should aim for 40° of inclination. When the original cup inclination was 40°, edge loading was prevented. Edge loading caused by steep cup inclination can be prevented by adjusting the cup orientation to account for predicted pelvic tilting, but spinal alignment must also be considered because lumbar kyphosis can increase postoperative pelvic posterior tilt.
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Affiliation(s)
- Takayuki Kyo
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan.
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31
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Steppacher SD, Albers CE, Siebenrock KA, Tannast M, Ganz R. Femoroacetabular impingement predisposes to traumatic posterior hip dislocation. Clin Orthop Relat Res 2013; 471:1937-43. [PMID: 23423625 PMCID: PMC3706669 DOI: 10.1007/s11999-013-2863-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 02/07/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic posterior hip dislocation in adults is generally understood to be the result of a high-energy trauma. Aside from reduced femoral antetorsion, morphologic risk factors for dislocation are unknown. We previously noticed that some hips with traumatic posterior dislocations had evidence of morphologic features of femoroacetabular impingement (FAI), therefore, we sought to evaluate that possibility more formally. QUESTIONS/PURPOSES We asked whether hips with a traumatic posterior hip dislocation present with (1) a cam-type deformity and/or (2) a retroverted acetabulum. METHODS We retrospectively compared the morphologic features of 53 consecutive hips (53 patients) after traumatic posterior hip dislocation with 85 normal hips (44 patients) based on AP pelvic and crosstable axial radiographs. We measured the axial and the lateral alpha angle for detection of a cam deformity and the crossover sign, ischial spine sign, posterior wall sign, retroversion index, and ratio of anterior to posterior acetabular coverage to describe the acetabular orientation. RESULTS Hips with traumatic posterior traumatic dislocation were more likely to have cam deformities than were normal hips, in that the hips with dislocation had increased axial and lateral alpha angles. Hips with posterior dislocation also were more likely to be retroverted; dislocated hips had a higher prevalence of a positive crossover sign, ischial spine sign, and posterior wall sign, and they had a higher retroversion index and increased ratio of anterior to posterior acetabular coverage. CONCLUSIONS Hips with posterior traumatic dislocation typically present with morphologic features of anterior FAI, including a cam-type deformity and retroverted acetabulum. An explanation for these findings could be that the early interaction between the aspherical femoral head and the prominent acetabular rim acts as a fulcrum, perhaps making these hips more susceptible to traumatic dislocation.
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Affiliation(s)
- Simon D. Steppacher
- />Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Christoph E. Albers
- />Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Klaus A. Siebenrock
- />Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Moritz Tannast
- />Department of Orthopaedic Surgery, Inselspital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Reinhold Ganz
- />Faculty of Medicine, University of Bern, Walchstrasse 10, 3073 Guemligen, Switzerland
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In vivo serum titanium ion levels following modular neck total hip arthroplasty--10 year results in 67 patients. Acta Biomater 2013; 9:6278-82. [PMID: 23232209 DOI: 10.1016/j.actbio.2012.12.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/28/2012] [Accepted: 12/02/2012] [Indexed: 02/01/2023]
Abstract
The objective of the present cross-sectional study was to determine in vivo titanium ion levels following cementless total hip arthroplasty (THA) using a modular stem system with different shapes for femoral canal fit and multiple neck options. A consecutive series of 173 patients (190 hips) who underwent cementless modular neck THA and a ceramic on polyethylene bearing with a median follow-up of 9 (7-13) years was evaluated retrospectively. According to a standardized protocol, titanium ion measurements were performed on 67 patients using high-resolution inductively coupled plasma-mass spectrometry. Ion levels were compared to a control group comprising patients with non-modular titanium implants (n=11) and to individuals without implants (n=23). Modular neck THA did not result in elevated titanium ion levels compared to non-modular THA. Compared to individuals without implants, both modular THA and non-modular THA showed elevated titanium ion levels. Absolute titanium ion levels, however, were comparatively low for both implants. The data suggest that the present modular stem system does not result in elevated systemic titanium ion levels in the medium term when compared to non-modular stems. Further longitudinal studies are needed to evaluate the use of systemic titanium ion levels as an objective diagnostic tool to identify THA failure and to monitor patients following revision surgery.
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33
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Evaluation of range of motion restriction within the hip joint. Med Biol Eng Comput 2012; 51:467-77. [PMID: 23263850 PMCID: PMC3589629 DOI: 10.1007/s11517-012-1016-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Accepted: 12/13/2012] [Indexed: 11/24/2022]
Abstract
In total hip arthroplasty, determining the impingement free range of motion requirement is a complex task. This is because in the native hip, motion is restricted by both impingement as well as soft tissue restraint. The aim of this study is to determine a range of motion benchmark which can identify motions which are at risk from impingement and those which are constrained due to soft tissue. Two experimental methodologies were used to determine motions which were limited by impingement and those motions which were limited by both impingement and soft tissue restraint. By comparing these two experimental results, motions which were limited by impingement were able to be separated from those motions which were limited by soft tissue restraint. The results show motions in extension as well as flexion combined with adduction are limited by soft tissue restraint. Motions in flexion, flexion combined with abduction and adduction are at risk from osseous impingement. Consequently, these motions represent where the maximum likely damage will occur in femoroacetabular impingement or at most risk of prosthetic impingement in total hip arthroplasty.
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Miki H, Kyo T, Sugano N. Anatomical hip range of motion after implantation during total hip arthroplasty with a large change in pelvic inclination. J Arthroplasty 2012; 27:1641-1650.e1. [PMID: 22521398 DOI: 10.1016/j.arth.2012.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Accepted: 03/01/2012] [Indexed: 02/01/2023] Open
Abstract
The supine functional pelvic plane is the recommended reference pelvic plane for acetabular cup planning in navigation-assisted total hip arthroplasty. However, it is unclear whether it can be used in patients with a large preoperative positional change in pelvic inclination (PC) from the supine to the standing position because it is unknown whether these patients have a different hip range of motion (ROM). We measured the anatomical hip ROM after implantation by computed tomography-based navigation in 91 patients and found it to be similar between those with a small PC (<10°) and those with a large PC (≥10°). There was no significant correlation between ROM and preoperative PC. The supine functional pelvic plane is adequate for cup planning whether the PC is small or large.
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Affiliation(s)
- Hidenobu Miki
- Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan
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35
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Renkawitz T, Haimerl M, Dohmen L, Gneiting S, Lechler P, Woerner M, Springorum HR, Weber M, Sussmann P, Sendtner E, Grifka J. The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty. BMC Musculoskelet Disord 2012; 13:65. [PMID: 22559740 PMCID: PMC3416712 DOI: 10.1186/1471-2474-13-65] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 05/04/2012] [Indexed: 11/30/2022] Open
Abstract
Background There is a complex interaction among acetabular component position and antetorsion of the femoral stem in determining the maximum, impingement-free prosthetic range-of-motion (ROM) in total hip arthroplasty (THA). By insertion into the femoral canal, stems of any geometry follow the natural anterior bow of the proximal femur, creating a sagittal Femoral Tilt (FT). We sought to study the incidence of FT as measured on postoperative computed tomography scans and its influence on impingement-free ROM in THA. Methods The incidence of the postoperative FT was evaluated on 40 computed tomography scans after cementless THA. With the help of a three-dimensional computer model of the hip, we then systematically analyzed the effects of FT on femoral antetorsion and its influence on calculations for a ROM maximized and impingement-free compliant stem/cup orientation. Results The mean postoperative FT on CT scans was 5.7° ± 1.8°. In all tests, FT significantly influenced the antetorsion values. Re-calculating the compliant component positions according to the concept of combined anteversion with and without the influence of FT revealed that the zone of compliance could differ by more than 200%. For a 7° change in FT, the impingement-free cup position differed by 4° for inclination when the same antetorsion was used. Conclusions A range-of-motion optimized cup position in THA cannot be calculated based on antetorsion values alone. The FT has a significant impact on recommended cup positions within the concept of “femur first” or “combined anteversion”. Ignoring FT may pose an increased risk of impingement as well as dislocation.
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Affiliation(s)
- Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University Medical Center, Regensburg, Germany.
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36
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Kouyoumdjian P, Coulomb R, Sanchez T, Asencio G. Clinical evaluation of hip joint rotation range of motion in adults. Orthop Traumatol Surg Res 2012; 98:17-23. [PMID: 22227606 DOI: 10.1016/j.otsr.2011.08.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 07/15/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Data on hip joint rotation range of motion (ROM) are rare; the methods of measurement vary and reproducibility has not been evaluated, in particular in relation to the subject's position (prone or supine, seated). HYPOTHESIS Hip joint rotation ROM is symmetrical, and ROM is not modified by the patient's position when data is obtained. PATIENTS AND METHODS This series included 120 adults between 20 and 60 years old (71 women, 49 men), who had no hip, spine or lower extremity disorders. External (ER) and internal (IR) rotation ROM was obtained using a photographic method by two observers. Measurements were obtained with the patient in three positions: the dorsal decubitus (supine) (P1), and ventral decubitus (prone) (P2) with the hip in extension and seated with the hip in flexion (P3). RESULTS Hip rotation ROM was P1: 68.1° (ER=38.5°; IR=29.6°); P2: 77.1°(ER=41.8°; IR=35.2°); P3: 78.5° (ER=78.5°; IR=37.9°) with no significant difference among the three positions. Interobserver reproducibility was satisfactory (concordance correlation coefficient (ccc) 0.7) and was comparable in the three positions with a ccc of 0.7072 (P1), 0.7426 (P2) and 0.7332 (P3), respectively. Hip rotation ROM balance was ER predominant in 47.5%, neutral in 39.5% and IR predominant in 13%. Hip rotation ROM balance was symmetric in both hips in 73 subjects (61%). Hip rotation ROM was reduced with age (P<0.0001), and was 4.7° less in men (P=0.0078), and in overweight subjects (P<0.0006). DISCUSSION Our values are probably lower than those in the literature because of the difference in study population. In our series, age, BMI and gender seemed to be determining factors. Hip rotation ROM balance is usually ER predominant or neutral. Hip rotation ROM can be measured in the three positions with no significant difference, with satisfactory interobserver reproducibility for each. TYPE OF STUDY Diagnostic prospective study: level III.
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Affiliation(s)
- P Kouyoumdjian
- Orthopaedic surgery and traumatology department, Carémeau Teaching Hospital Center, Nimes cedex 9, France.
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37
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Girard J, Krantz N, Bocquet D, Wavreille G, Migaud H. Femoral head to neck offset after hip resurfacing is critical for range of motion. Clin Biomech (Bristol, Avon) 2012; 27:165-9. [PMID: 21925779 DOI: 10.1016/j.clinbiomech.2011.08.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/25/2011] [Accepted: 08/25/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Range of motion after hip arthroplasty may be limited by soft tissues around the hip, extra-articular contact and femoral stem-neck contact with the acetabular articular surface. Femoral head-neck diameter ratio is recognized as a major factor influencing hip range of motion. In hip resurfacing, range of motion is constrained by "cup component to femoral neck" contact. To avoid cup-to-bone contact or to increase the degree of flexion at which it occurs, anterior translation of the femoral component relative to the central femoral neck axis may improve anterior head-neck offset and hip flexion. We questioned whether low or high anterior femoral head to neck offset, cup inclination, stem anteversion, and component size influenced postoperative range of motion and hip flexion in patients who had undergone hip resurfacing. METHODS We prospectively followed 66 patients (68 hips) who underwent hip resurfacing at a mean age at operation of 46.4 years (range, 19-60 years). Mean follow-up was 37.5 months (range, 33-41 months). No patient was lost to follow-up. All patients were evaluated clinically and range of motion was precised. Radiological measurement evaluated the anterior femoral head-neck offset. FINDINGS Mean anterior neck-head offset was 7.5mm (range, 5-12 mm). We found significant linear regression correlation between anterior offset and flexion (R=0.66) and between anterior offset and global range of motion (R=0.51). One millimeter of anterior offset increased hip range of motion by 5° in flexion. No significant correlations were found between global range of motion or flexion arc of motion and component size, stem anteversion, cup inclination, gender ratio, preoperative arc of flexion or global range of motion. INTERPRETATION Restoring or improving deficient anterior femoral head-neck offset appears important for restoring postoperative range of motion and specifically hip flexion.
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Affiliation(s)
- J Girard
- University Lille Nord de France, F-59000 Lille, France.
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38
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Patel D, Goswami T. Influence of design parameters on cup-stem orientations for impingement free RoM in hip implants. Med Eng Phys 2011; 34:573-8. [PMID: 21978913 DOI: 10.1016/j.medengphy.2011.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/07/2011] [Accepted: 09/06/2011] [Indexed: 11/17/2022]
Abstract
This study was conducted to study the influence of design parameters namely; the head/neck ratio (R), neck-shaft angle (NSA), oscillation angle (OsA) and stem offset (Sθ) on cup-stem orientations namely; the cup inclination (CI), cup anteversion (CA) and stem antetorsion (SA). R is often linked to influence NSA, OsA and impingement. An effort has been made to analyze range of motion (RoM) with NSA greater than 135° and R lower than 2.3 that may produce impingement. This study attempted to answer the following assumptions whether (a) implants with higher H-N ratio can achieve higher oscillations and higher stem antetorsion, (b) stems with higher neck shaft angle can achieve higher cup anteversion with lower stem offset and stem antetorsion, (c) stem with higher offsets can achieve lower cup anteversion with higher stem antetorsion, and (d) lower cup anteversion can be achieved when stem antetorsion is higher. A theoretical and a simulated method were implemented to anaylze RoM until impingement between cup and neck occurred. Cup abduction and anterior opening were held constant for this study. Multivariate prediction models were developed to predict optimal cup-stem orientations for the chosen design parameters of 12 hip implants. Optimal design parameters to achieve an impingement free RoM were as follows: NSA=139.25°, R=3.08, OsA=119.83°, Sθ=34.45mm, CA(predicted)=16.26°, CI(predicted)=42.77° and SA(predicted)=30.37°, respectively. Multivariate models may be further developed for use in surgery planning to achieve optimal component placement.
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Affiliation(s)
- Dishita Patel
- Biomedical, Industrial and Human Factors Engineering, Wright State University, 3640 Colonel Glenn Hwy, Dayton, OH 45435, USA.
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Fottner A, Peter CV, Schmidutz F, Wanke-Jellinek L, Schröder C, Mazoochian F, Jansson V. Biomechanical evaluation of different offset versions of a cementless hip prosthesis by 3-dimensional measurement of micromotions. Clin Biomech (Bristol, Avon) 2011; 26:830-5. [PMID: 21536357 DOI: 10.1016/j.clinbiomech.2011.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cementless hip prostheses with different offsets are frequently used to restore the rotation center of the hip. However, a rising offset is theoretically associated with a potential risk for increased interface stresses and early loosening. METHODS To assess this potential risk for cementless stems, the primary stability of the CLS Spotorno stem was examined with respect to three different femoral neck versions (125°, 135° and 145°) measuring 3-dimensional micromotions. For this purpose 18 stems were implanted in composite femurs and tested dynamically using physiological loading conditions considering the necessary adaptation according to the different offsets. Additionally the deformations at the surface of the composite femur were recorded to draw conclusions about the tendency for stress shielding. FINDINGS The micromotions of the different offset versions were not significantly different. The highest values were obtained at the tip of the stems, even exceeding the critical limit for osseous integration of 150μm. Compared to untreated composite femurs the alteration of the deformations at the surface remained relatively low. A significant difference was only observed in the ventral measurement points. INTERPRETATION According to the measured micromotions no offset version of the CLS Spotorno can be declared as superior. The assumption that the varus version is characterized by extended interface stresses could not be confirmed. Furthermore, it could be demonstrated that according to the principle of proximal load transfer of the CLS Spotorno stem an osseous integration of the distal part cannot be expected and that the risk for stress shielding appears to be relatively low.
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Affiliation(s)
- Andreas Fottner
- Department of Orthopaedic Surgery, University Hospital of Munich (LMU), Campus Grosshadern, Germany.
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Turley GA, Ahmed SMY, Williams MA, Griffin DR. Establishing a range of motion boundary for total hip arthroplasty. Proc Inst Mech Eng H 2011; 225:769-82. [DOI: 10.1177/0954411911409306] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Range of motion of the hip joint is a major contributor to dislocation post total hip replacement. Impingement is often treated as a surrogate for dislocation and occurs – prosthetically – when the neck of the femoral component contacts with the rim of the pelvic acetabular cup. This impingement is caused by movement of the leg during activities of daily living. This article analyses hip joint range of motion and its implication for impingement. A systematic literature review was undertaken with the purpose of establishing a range of motion benchmark for total hip replacement. This paper proposes a method by which a three-dimensional range of motion boundary established from the literature can be presented. The nominal boundary is also validated experimentally using a number of configurations of a neutral hip joint coordinate frame.
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Affiliation(s)
- G A Turley
- WMG, The University of Warwick, Coventry, UK
| | - S M Y Ahmed
- Warwick Medical School, The University of Warwick, Coventry, UK
| | | | - D R Griffin
- Warwick Medical School, The University of Warwick, Coventry, UK
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Lin F, Lim D, Wixson RL, Milos S, Hendrix RW, Makhsous M. Limitations of imageless computer-assisted navigation for total hip arthroplasty. J Arthroplasty 2011; 26:596-605. [PMID: 20817389 DOI: 10.1016/j.arth.2010.05.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2009] [Accepted: 05/25/2010] [Indexed: 02/01/2023] Open
Abstract
We prospectively evaluated acetabular cup placement in total hip arthroplasty with an imageless computer navigation system or using conventional manual technique. The achieved cup orientation in the manual group had substantially larger variances and greater placement error than the navigation cases. The use of navigation was abandoned in 3 cases because of excessive pelvic tilt and unreliable registration of the pelvis. Computer navigation system helped improve the accuracy of the acetabular cup placement for total hip arthroplasty in this study. The variation between the intraoperative navigation readings and the computed tomographic values suggests that relying on palpation of bony landmarks through drapes and tissue is a limitation of this method. Further, the variation in pelvic tilt has an effect on cup placement that requires further studies.
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Affiliation(s)
- Fang Lin
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois 60611, USA
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Jauch SY, Huber G, Hoenig E, Baxmann M, Grupp TM, Morlock MM. Influence of material coupling and assembly condition on the magnitude of micromotion at the stem-neck interface of a modular hip endoprosthesis. J Biomech 2011; 44:1747-51. [PMID: 21531416 DOI: 10.1016/j.jbiomech.2011.04.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 02/25/2011] [Accepted: 04/04/2011] [Indexed: 11/29/2022]
Abstract
Hip prostheses with a modular neck exhibit, compared to monobloc prostheses, an additional interface which bears the risk of fretting as well as corrosion. Failures at the neck adapter of modular prostheses have been observed for a number of different designs. It has been speculated that micromotions at the stem-neck interface were responsible for these implant failures. The purpose of this study was to investigate the influence of material combinations and assembly conditions on the magnitude of micromotions at the stem-neck interface during cyclic loading. Modular (n = 24) and monobloc (n = 3) hip prostheses of a similar design (Metha, Aesculap AG, Tuttlingen, Germany) were subjected to mechanical testing according to ISO 7206-4 (F(min) = 230N, F(max) = 2300N, f = 1Hz, n = 10,000 cycles). The neck adapters (Ti-6Al-4V or Co-Cr29-Mo alloy) were assembled with a clean or contaminated interface. The micromotion between stem and neck adapter was calculated at five reference points based on the measurements of the three eddy current sensors. The largest micromotions were observed at the lateral edge of the stem-neck taper connection, which is in accordance with the crack location of clinically failed prostheses. Titanium neck adapters showed significantly larger micromotions than cobalt-chromium neck adapters (p = 0.005). Contaminated interfaces also exhibited significantly larger micromotions (p < 0.001). Since excessive micromotions at the stem-neck interface might be involved in the process of implant failure, special care should be taken to clean the interface prior to assembly and titanium neck adapters with titanium stems should generally be used with caution.
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Affiliation(s)
- S Y Jauch
- Biomechanics Section, TUHH Hamburg University of Technology, Denickestr 15, 21073 Hamburg, Germany.
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Lavigne M, Ganapathi M, Mottard S, Girard J, Vendittoli PA. Range of motion of large head total hip arthroplasty is greater than 28 mm total hip arthroplasty or hip resurfacing. Clin Biomech (Bristol, Avon) 2011; 26:267-73. [PMID: 21122957 DOI: 10.1016/j.clinbiomech.2010.11.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 11/01/2010] [Accepted: 11/01/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reduced range of motion of the hip has a detrimental influence on lower limb function. Large diameter head total hip arthroplasty may theoretically have a greater potential for restoring normal hip range of motion due to greater head-neck diameter ratio, and hence provide better function compared to conventional or hip resurfacing arthroplasty. METHOD At minimum one year follow-up, range of motion of the operated and contra lateral hips was clinically assessed using digital photographs and bony landmarks in a clinical comparative study. We assessed if 1) large diameter head total hip arthroplasty (55 patients) restores better hip range of motion compared to 28 mm total hip arthroplasty (50 patients) or hip resurfacing (60 patients) 2) large diameter head total hip arthroplasty achieves same hip range of motion as contra lateral normal hips and 3) hip range of motion correlates with the WOMAC score. FINDINGS The large diameter head total hip arthroplasty group had significantly greater total arcs of motion (approximately 20°), mostly due to an increase of hip flexion and external rotation, but did not reach normal hip motion. The hip range of motion showed significant correlation with the WOMAC score, especially the flexion arc. INTERPRETATION The better hip range of motion of large diameter head total hip arthroplasty is likely due to the greater head to neck diameter ratio and hence seems to be the best option to optimize range of hip motion and improve function after hip arthroplasty.
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Affiliation(s)
- Martin Lavigne
- Department of Surgery, Montreal University, Quebec, Canada.
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Kurtz WB, Ecker TM, Reichmann WM, Murphy SB. Factors affecting bony impingement in hip arthroplasty. J Arthroplasty 2010; 25:624-34.e1-2. [PMID: 19559561 DOI: 10.1016/j.arth.2009.03.024] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 03/28/2009] [Indexed: 02/01/2023] Open
Abstract
Computer modeling of 10 patients' computed tomographic scans was used to study the variables affecting hip arthroplasty range of motion before bony impingement (ROMBI) including acetabular offset and height, femoral offset, height and anteversion, and osteophyte removal. The ROMBI was compared with the ROM before component impingement and the native hip ROM. The ROMBI decreased with decreased total offset and limb shortening. Acetabular offset and height had a greater effect on ROMBI than femoral offset and height. The ROMBI lost with decreased acetabular offset was not fully recoverable with an increase in femoral offset or osteophyte removal. Bony impingement increased and component impingement decreased with decreased acetabular offset and increased head diameter.
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A three-dimensional parameterized and visually kinematic simulation module for the theoretical range of motion of total hip arthroplasty. Clin Biomech (Bristol, Avon) 2010; 25:427-32. [PMID: 20189695 DOI: 10.1016/j.clinbiomech.2010.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 01/20/2010] [Accepted: 01/21/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Proper option and optimal alignment of implants are major factors in obtaining the desired range of motion of total hip arthroplasty. It would be very useful if a tool is available to assist clinicians to preoperatively determine proper implants and their optimal intraoperative alignment for individual patient. METHODS Based on the secondary development function of ADAMS/VIEW, a three-dimensional parameterized module was developed to simulate six motions of implants for total hip arthroplasty. Total eight parameters (stem abduction, acetabular size, head size, general head-neck ratio, stem-neck angle, acetabular anteversion, acetabular inclination and femoral antetorsion) were included and three definitions of acetabular orientations (operative, radiographic and anatomical) were available. Any initial position of implants and simulation precision could be defined on the demand. FINDINGS After entering these eight parameters, a special model of total hip arthroplasty would be constructed. Single or combined motion until the prosthetic impingement could be simulated visually and the corresponding maximal rotation angle would be quantified. INTERPRETATION Clinical factors, such as patients with severe deformity of hip joint or a large range of motion demand, should be considered during total hip arthroplasty. This module can provide references for clinicians on proper option and intraoperative implantation of components, and be suitable for postoperative evaluation. Furthermore, it is a tool to investigate the "safe-zones" of total hip arthroplasty and also can be employed for the design of new implant system.
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Malviya A, Lingard EA, Malik A, Bowman R, Holland JP. Hip flexion after Birmingham hip resurfacing: role of cup anteversion, anterior femoral head-neck offset, and head-neck ratio. J Arthroplasty 2010; 25:387-91. [PMID: 19285379 DOI: 10.1016/j.arth.2009.01.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 11/12/2008] [Accepted: 01/25/2009] [Indexed: 02/01/2023] Open
Abstract
We aimed to investigate the factors affecting range of flexion after hip resurfacing. A total of 82 cases, operated by a single surgeon, were assessed at a mean of 43 months. The Einzel-Bild-Roentgen-Analysis for the acetabular cup software was used to measure socket orientation. Range of flexion had a moderate positive correlation with cup anteversion (R = 0.26, P = .017), weak but significant negative correlation with neck diameter (R = -0.23, P = .042), and none with anterior femoral head-neck offset. Using multivariate analysis that adjusted for age, sex, cup anteversion and inclination, head-neck offset ratio, head-neck ratio, and neck diameter, the only significant correlate of flexion was cup anteversion (P = .017). Care should be taken during cup placement to allow adequate anteversion to be maintained in Birmingham hip resurfacing because this can affect flexion range of motion.
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Affiliation(s)
- Ajay Malviya
- Department of Orthopaedics, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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Omlor GW, Ullrich H, Krahmer K, Jung A, Aldinger G, Aldinger P. A stature-specific concept for uncemented, primary total hip arthroplasty. Acta Orthop 2010; 81:126-33. [PMID: 20146639 PMCID: PMC2856217 DOI: 10.3109/17453671003587077] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE Variations in hip anatomy limit the femoral canal fit of standard uncemented hip stems. In addition, there are still issues with leg length discrepancy and offset reconstruction, potentially resulting in impingement, dislocation, and wear. Modular stems with different shapes for femoral canal fit and multiple neck options may improve the outcome and reduce complications. PATIENTS AND METHODS 173 patients (190 hips) received an uncemented THA with 1 of 2 different stem shapes for canal fit and a modular neck for stature-specific hip reconstruction. Median follow-up time was 9 (7-13) years. During the follow-up period, 20 patients died (22 hips) and 12 patients (13 hips) were lost to follow-up. 155 hips were available for evaluation, including clinical and radiological outcome. RESULTS 1 stem was revised for a periprosthetic fracture following trauma; 10 cups and 2 modular necks were revised (1 for breakage and 1 during cup revision). At 10 years, stem survival was 100%, modular neck survival was 99% (CI: 95-100), and cup survival was 94% (CI: 87-97). No leg length discrepancies were measured in 96% of cases. Offset with anatomic lateralization was achieved in 98%. Median Harris hip score was 94 (47-100) and median Merle d'Aubigné score was 16 (10-18). Relevant radiolucent lines and osteolysis were not found. INTERPRETATION The uncemented modular neck, dual-stem system used in this series allows accurate reconstruction of the joint by adapting the implant to the needs of the patient. This may improve the outcome of primary THA, which is supported by the results of this medium-term follow-up evaluation.
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Affiliation(s)
- Georg W Omlor
- Department of Orthopaedic Surgery, University of Heidelberg
| | - Hannah Ullrich
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie-Klinikum, StuttgartGermany
| | - Knut Krahmer
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie-Klinikum, StuttgartGermany
| | - Alexander Jung
- Department of Orthopaedic Surgery, University of Heidelberg
| | - Günther Aldinger
- Department of Orthopaedic Surgery Paulinenhilfe, Diakonie-Klinikum, StuttgartGermany
| | - Peter Aldinger
- Department of Orthopaedic Surgery, University of Heidelberg
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Abstract
BACKGROUND AND PURPOSE Many studies have suggested that navigation-based implantation can improve cup positioning in total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to compile the best available evidence, and to overcome potential shortcomings because of small sample sizes in individual studies. METHODS The search strategy covered the major medical databases from January 1976 through August 2007, as well as various publishers' databases. The internal validity of individual studies was evaluated independently by 3 reviewers. We used random-effects modeling to obtain mean differences in cup angulation and relative risk (RR) of cup positioning outside Lewinnek's safe zone. RESULTS Of 363 citations originally identified, 5 trials of moderate methodology enrolling a total of 400 patients were included in the analysis. Mean cup inclination and anteversion were not statistically significantly different between the conventional groups and the navigated groups. Navigation reduced the variability in cup positioning and the risk of placing the acetabular component beyond the safe zone (RR = 0.21, CI: 0.13-0.32). INTERPRETATION Based on the current literature, navigation is a reliable tool to optimize cup placement, and to minimize outliers. However, long-term outcomes and cost utility analyses are needed before conclusive statements can be drawn about the value of routine navigation in THA.
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Affiliation(s)
- Johannes Beckmann
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Dirk Stengel
- Depts f Trauma and Orthopaedic Surgery, Unfallkrankenhaus Berlin and University of GreifswaldGermany
| | - Markus Tingart
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Jürgen Götz
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Joachim Grifka
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
| | - Christian Lüring
- Department of Orthopedic Surgery, University of RegensburgBad AbbachGermany
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Cup positioning in THA: current status and pitfalls. A systematic evaluation of the literature. Arch Orthop Trauma Surg 2009; 129:863-72. [PMID: 18600334 DOI: 10.1007/s00402-008-0686-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Indexed: 10/21/2022]
Abstract
The correct determination of cup orientation in THA regarding the intraoperative as well as the postoperative assessment due to the pelvic tilt and rotation with inexact incorporation of the pelvis is uncertain. The anterior pelvic plane (APP) seems to be the most reliable reference frame and computer-assisted navigation systems seem to provide the best tool for correct implantation to date. For the intraoperative assessment of the APP, the exact determination of the bony landmarks is mandatory. For the standard plain radiography, standardized positioning of the patient and approximation of pelvic tilt by a lateral view are mandatory. An additional CT must be carried out for certain indications. More emphasis has to be given to the individuality of pelvic tilt and range of motion.
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Computer-assisted versus manual alignment in THA: a probabilistic approach to range of motion. Clin Orthop Relat Res 2009; 467:50-5. [PMID: 18941857 PMCID: PMC2600980 DOI: 10.1007/s11999-008-0561-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Accepted: 09/23/2008] [Indexed: 01/31/2023]
Abstract
Dislocation remains a major complication after THA, and range of motion before impingement is important in joint stability. Variability in implant alignment affects resultant range of motion. We used a probabilistic modeling approach to assess the effects of implant alignment variability based on manual and computer-assisted surgical (CAS) techniques on resultant range of motion after THA. We implemented a contact detection algorithm within a probabilistic analysis framework. The normally distributed alignment variables (mean +/- 1 standard deviation) were cup abduction (manual = 45 degrees +/- 7.6 degrees , CAS = 45 degrees +/- 5.7 degrees ), cup anteversion (manual = 20 degrees +/- 9.6 degrees , CAS = 20 degrees +/- 4.5 degrees ), and stem anteversion (manual and CAS = 10 degrees +/- 1.5 degrees ). The outcomes of the probabilistic analysis were range of motion distributions with 1% and 99% bounds. The upper bounds of motion for manual and CAS alignment were similar because bony impingement was the limiting factor. The lower bounds of range of motion were substantially different depending on the type of surgical alignment; manual alignment produced a smaller range of motion in 3% to 5% of cases. CAS implant alignment produced range of motion values above minimum acceptable levels in all cases simulated.
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