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Huang D, Chen Z, Yan X, Huang X, Liu M, Yao Z, Li H, Qu H, Ma X, Ye Z, Lin N. Novel positioning guiders accurately assist in situ acetabular reconstruction for patients undergoing pelvic bone tumor resection. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2963-2972. [PMID: 38836905 DOI: 10.1007/s00590-024-04020-7] [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: 04/28/2024] [Accepted: 05/31/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Acetabular reconstruction in situ after extensive pelvic resection is technically challenging. The aim of this study was to investigate the feasibility of positioning guiders for acetabular reconstruction following pelvic tumor resection and the clinical benefit brought by the approach. METHODS The study included patients who underwent acetabular reconstruction following periacetabular tumor resection using a modular hemipelvic prosthesis. In the guider-assisted group (n = 14), guiders were designed and applied to assist acetabular reconstruction. In the traditional operation group (n = 18), the patients underwent the same surgery but without the guiders. The displacement of the hip rotation center before and after surgery was calculated. The complications and the Musculoskeletal Tumor Society-93 scores were documented. RESULTS The overall displacement of the hip rotation center was significantly reduced in the guider-assisted group compared with the traditional operation group (13.83 ± 4.06 vs. 22.95 ± 9.18 mm in P = 0.000, 95%CI 3.90-12.96), especially in the anteroposterior axis (3.77 ± 3.03 versus 13.51 ± 9.43 mm in P = 0.000, 95%CI 3.45-13.09). Guider-assisted acetabular reconstruction reduced the risk of prosthesis dislocation compared with the traditional operation (dislocation risks: 1/14, 7.1% vs. 4/18, 22.2%). CONCLUSION Positioning guiders can effectively and conveniently help place the modular hemipelvic prosthesis at the native position, which might potentially reduce the risk of prosthesis dislocation. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Donghua Huang
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Zehao Chen
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Xiaobo Yan
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Xin Huang
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Meng Liu
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Zhaonong Yao
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Hengyuan Li
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Hao Qu
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Xiao Ma
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Zhaoming Ye
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China
| | - Nong Lin
- Musculoskeletal Tumor Center, Department of Orthopedics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou City, People's Republic of China.
- Orthopedics Research Institute of Zhejiang University, Hangzhou City, Zhejiang Province, People's Republic of China.
- Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China.
- Clinical Research Center of Motor System Disease of Zhejiang Province, Hangzhou City, Zhejiang Province, People's Republic of China.
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Maciąg B, Jegierski D, Wilk B, Budzińska M, Maciąg G, Kupczak A, Żarnovsky K, Łapiński M, Kordyaczny T, Stolarczyk A. Impact of acetabular roof's angle on precision of cup center of rotation reproduction and placement in total hip arthroplasty. Reumatologia 2024; 62:128-133. [PMID: 38799773 PMCID: PMC11114134 DOI: 10.5114/reum/186724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/02/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Total hip arthroplasty (THA) is nowadays considered as the most effective treatment option for end-stage hip osteoarthritis (OA) and one of the most successful orthopedic procedures. Precise reproduction of the center of rotation (COR) is among the most important aspects of recreating native hip biomechanics after THA as it is strictly related to muscle tension and force distribution within the hip joint. Both vertical and horizontal shift in cup positioning and COR restoration are commonly observed radiological signs corresponding with lesser functional outcome. The aim of this study was to assess whether the superior border of the native acetabulum morphology has an impact on cup positioning and COR restoration in patients undergoing THA as treatment of primary OA of the hip. Material and methods A cohort of 150 consecutive patients with diagnosis of end-stage primary hip OA who underwent THA via an anterolateral approach with the same implant in 2021 was analyzed retrospectively. Standard standing pelvic X-rays were performed pre- and postoperatively and appropriate measurements were taken. Several radiological parameters on obtained X-rays were assessed. Statistical analysis of all the measurements was performed. Results There was a statistically significant positive weak correlation between cup offset and acetabular roof angle (rs = 0.25, p = 0.002). There were statistically insignificant positive correlations between acetabular roof angle and COR restoration (rs = 0.14, p = 0.097), acetabular roof angle and total offset (rs = 0.087, p = 0.29) and a negative correlation between acetabular roof angle and femoral offset (rs = 0.071, p = 0.39). Conclusions The present study revealed that preoperative acetabular roof angle influences the positioning of the prosthetic cup in the transverse axis. There also seems to be a correlation between the acetabular roof angle and COR restoration, but its significance needs further evaluation. Surgeons could use this knowledge to preoperatively assess the risk of cup malposition and adjust their technique during the THA procedure with probable improvement of hip function.
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Affiliation(s)
- Bartosz Maciąg
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Dawid Jegierski
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Bartłomiej Wilk
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Martyna Budzińska
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Grzegorz Maciąg
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Anna Kupczak
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Krystian Żarnovsky
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Marcin Łapiński
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Tomasz Kordyaczny
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
| | - Artur Stolarczyk
- Department of Orthopedics and Rehabilitation, Miedzyleski Specialist Hospital, Medical University of Warsaw, Poland
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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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Viglietta E, Previ L, Giuliani V, Rescigno G, Gugliotta Y, Redler A, Iorio R. "Single-use peripheral" vs "conventional" reaming in total hip arthroplasty: how to respect native centre of rotation and acetabular offset? A CT study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2737-2742. [PMID: 37541983 PMCID: PMC10602958 DOI: 10.1007/s00264-023-05899-3] [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: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023]
Abstract
PURPOSE The respect of native hip offset represents a mainstay for satisfying results in total hip arthroplasty (THA). Historically, a great interest has been focused on restoration of femoral offset, while only in recent years, acetabular offset (AO) has been considered. The purpose of the current study was to compare the "single-use peripheral" reaming technique with the "conventional" one for the maintenance of the native COR of the hip and AO in patients undergoing to primary THA. METHODS Eighty patients affected from primary hip osteoarthritis were prospectively enrolled in the study and were divided in two groups (Group A "single-use peripheral" and Group B "conventional" reaming technique). Pre- and post-operatively, AO, acetabular floor distance (AFd) and acetabular version (AV) were assessed through a CT scan. A comparison between groups for the radiological parameters, surgical time and complications was performed. RESULTS The demographic data were similar in both groups. The complications rate and the AV did not differ statistically between groups. Group A presented a statistically significant shorter surgical time and lower variation between pre- and post-operative AO and AFd. Statistical significance was defined as p < 0.05. CONCLUSIONS The "single-use peripheral" reaming technique demonstrated to be more reliable in reproducing the native COR and AO of patients undergoing to primary THA than the "conventional" one. The operative time was significantly reduced, and it may lead to a reduction in the infection risk even though it was not observed in the current study. Further research could be useful to validate such findings and to assess clinical impact and long-term survival of the implant.
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Affiliation(s)
- Edoardo Viglietta
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy.
| | - Leonardo Previ
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Veronica Giuliani
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Giulia Rescigno
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Yuri Gugliotta
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Andrea Redler
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
| | - Raffaele Iorio
- Orthopaedic Unit, S. Andrea Hospital, University of Rome, "La Sapienza" Via Di Grottarossa 1035, Rome, Italy
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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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Kunze KN, Premkumar A, Bovonratwet P, Sculco PK. Acetabular Component and Liner Selection for the Prevention of Dislocation After Primary Total Hip Arthroplasty. JBJS Rev 2021; 9:01874474-202112000-00004. [PMID: 34910697 DOI: 10.2106/jbjs.rvw.21.00148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Primary total hip arthroplasty (THA) is a reproducible and efficacious procedure for patients with end-stage osteoarthritis; however, dislocation remains the most common cause of revision arthroplasty. » Technological advancements in acetabular component design and liner options, in conjunction with a more comprehensive understanding of the spinopelvic factors that influence dislocation, will likely reduce the risk of dislocation and revision over time. » The contemporary liner and shell options for primary THA, in order of increasing constraint and stability, include (1) neutral, (2) lateralized, (3) face-changing (oblique), (4) lipped (high-wall) with or without lateralization, (5) modular and anatomic dual-mobility, and (6) constrained options. » Different liner designs can alter functional anteversion, inclination, and jump distance, and can be used to minimize a single predictable dislocation vector (lipped [high-wall] liners) or multiple vectors of instability risk when the dislocation direction is unpredictable (dual-mobility liners). » Liner selection should be based on the patient-specific risk of dislocation, including static anatomic (e.g., large anterior inferior iliac spine or greater trochanter morphology), dynamic anatomic (e.g., limited sitting-standing change in the sacral slope), and demographic or medical (e.g., neurocognitive disorders and obesity) risk factors.
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Affiliation(s)
- Kyle N Kunze
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY
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Wang H, Tang X, Ji T, Yan T, Yang R, Guo W. Risk factors for early dislocation of the hip after periacetabular tumour resection and endoprosthetic reconstruction of the hemipelvis. Bone Joint J 2021; 103-B:382-390. [PMID: 33517736 DOI: 10.1302/0301-620x.103b2.bjj-2020-0928.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is an increased risk of dislocation of the hip after the resection of a periacetabular tumour and endoprosthetic reconstruction of the defect in the hemipelvis. The aim of this study was to determine the rate and timing of dislocation and to identify its risk factors. METHODS To determine the dislocation rate, we conducted a retrospective single-institution study of 441 patients with a periacetabular tumour who had undergone a standard modular hemipelvic endoprosthetic reconstruction between 2003 and 2019. After excluding ineligible patients, 420 patients were enrolled. Patient-specific, resection-specific, and reconstruction-specific variables were studied using univariate and multivariate analyses. RESULTS The dislocation rate was 9.3% (n = 41). Dislocation was most likely to occur in the first three months after surgery. Four independent risk factors were found, one of which was older age at operation (p = 0.039). The odds ratios (ORs) of those aged ≥ 60 years and 30 to 60 years were 8.50 and 4.64, respectively, compared with those aged < 30 years. The other three risk factors were resection of gluteus maximus (p = 0.010, OR = 5.8), vertical shift of the centre of rotation (COR) of the hip by ≥ 20 mm (p = 0.008, OR = 3.60), and a type I+II+III pelvic resection (p = 0.014, OR = 3.04). CONCLUSION Hemipelvic endoprosthetic reconstruction after resection of a periacetabular tumour has a dislocation rate of 9.3% (n = 41). Patients are most likely to dislocate in the first three months after surgery. The risk is increased for older patients (especially those aged > 60 years) and for those with gluteus maximus resection, vertical shift of the COR ≥ 20 mm, and a type I+II+III pelvic resection. Cite this article: Bone Joint J 2021;103-B(2):382-390.
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Affiliation(s)
- Han Wang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
| | - Xiaodong Tang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
| | - Tao Ji
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
| | - Taiqiang Yan
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
| | - Rongli Yang
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
| | - Wei Guo
- Musculoskeletal Tumour Centre, Peking University People's Hospital, Beijing, China
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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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9
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Benson JR, Govindarajan M, Muir JM, Lamb IR, Sculco PK. Surgical Approach and Reaming Depth Influence the Direction and Magnitude of Acetabular Center of Rotation Changes During Total Hip Arthroplasty. Arthroplast Today 2020; 6:414-421. [PMID: 32577487 PMCID: PMC7305266 DOI: 10.1016/j.artd.2020.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/23/2020] [Accepted: 04/02/2020] [Indexed: 12/01/2022] Open
Abstract
Background Changes in acetabular or hip center of rotation (HCOR) commonly occur during acetabular component preparation during total hip arthroplasty (THA). HCOR displacement in mediolateral or superoinferior directions is known to influence offset and leg length, but the incidence and range of HCOR change in the anteroposterior direction is less understood as the sagittal plane cannot be measured on standard anteroposterior radiographs. This study assessed the 3-dimensional displacement of HCOR after cup implantation and evaluated for potential factors associated with increased acetabular component translations. Methods A total of 894 THAs were performed using a posterior, lateral, or direct anterior approach. Only intraoperative data from the navigation device were included in the analysis. All THAs performed between September 2015 and October 2017 were included. Paired t-tests were used to compare native HCOR and new HCOR values. Results The mean HCOR displacement in 3 directions was 4.97mm medially (P < .001), 0.83mm superiorly (P < .001), and 0.64mm posteriorly (P < .001). Subgroup analysis revealed greater posterior HCOR displacement with the anterior approach than the lateral/posterior approach (2.32mm vs 0.44mm; P < .001). Increasing medial HCOR displacement also resulted in increased superior and posterior HCOR displacement across surgical cases (P < .001). Conclusions HCOR displacement is commonly observed in medial, superior, and posterior directions. HCOR changes are influenced by surgical approach, potentially secondary to patient positioning, with greater posterior HCOR displacement observed in anterior cases. Surgeons should be aware of these factors, particularly in cases with deficient or reduced posterior column bone stock.
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Affiliation(s)
- Jessica R Benson
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Meinusha Govindarajan
- Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Jeffrey M Muir
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Iain R Lamb
- Department of Clinical Research, Intellijoint Surgical, Inc., Kitchener, Ontario, Canada
| | - Peter K Sculco
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
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10
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Maillot C, Auvinet E, Harman C, Cobb J, Rivière C. Hip resurfacing generates a more physiological gait than total hip replacement: A case-control study. Orthop Traumatol Surg Res 2020; 106:527-534. [PMID: 32265178 DOI: 10.1016/j.otsr.2019.12.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Restoration of the constitutional joint anatomy after hip replacement favours physiological peri-articular soft-tissue tension and kinematics, and is likely to be functionally beneficial. Hip resurfacing (HR) and conventional total hip replacement (THR) are two different options for replacing degenerated hips, and are likely to result in different anatomical reconstruction. We initiated this study to investigate the differences in gait performance between these two prosthetic options, and aimed to answer the following questions: (1) does HR result in better restoration of the frontal hip anatomical parameters, (2) and generate a more physiological gait compared to THR? (3) Does the quality of the anatomical restoration after THR influence gait performance? HYPOTHESES Our hypothesis was that a better anatomical restoration using HR versus THR would produce more physiological (symmetric) gait. METHODS We retrospectively reviewed 52 patients who had unilateral primary osteoarthritis successfully treated by replacement (40 THRs and 12 HRs). Hip anatomical parameters were measured on standing pelvic radiographs on both the prosthetic and the contralateral healthy hips. Patients undertook gait assessment under both normal and stress conditions at a mean follow-up of 14 months (7 to 16 months). Gait performances were compared between HR and THR, and the relationship between gait performances and quality of frontal anatomical restoration (estimated on radiograph) were assessed. RESULTS Compared to the native contralateral side, the HR procedure tended to decrease all independent anatomical radiographic parameters with the exception of the vertical centre of rotation offset, whilst the THR procedure tended to increase them; the difference between HR and THR was only statistically significant for femoral offset and global horizontal offset (increased after THR while reduced after HR). Only 50% of THR and 25% of HR procedures closely anatomically (±15%) recreated both global horizontal offset and global vertical offset. Under normal conditions (normal walking speed and flat ramp), the gait was fairly symmetric for both the HR and the THR patients with a symmetry index of 0.62% and 3.14% respectively. At high walking speed (stress conditions), the symmetry index degraded for both groups, but the gait remained more symmetric in the HR group (2.09%), compared to the THR group (5.74%); nevertheless, the difference remained not statistically significant (p=0.159). We were unable to detect any significant relationship between gait performances and radiographically measured hip frontal anatomical parameters. DISCUSSION/CONCLUSIONS HR procedure is more consistent than conventional THR in generating a more physiological gait under stress conditions. Radiographic estimation of the quality of the frontal anatomical hip restoration is of poor value to predict gait performances of THR patients. LEVEL OF EVIDENCE III - retrospective case-control study with prospective data collection.
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Affiliation(s)
- Cedric Maillot
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Edouard Auvinet
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Ciara Harman
- South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom
| | - Justin Cobb
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom
| | - Charles Rivière
- Laboratory Block, MSK Lab, Imperial college London, White City Campus, W12 0BZ London, United Kingdom; South West London Elective Orthopaedic Centre, Dorking road, KT18 7EG Epsom, United Kingdom.
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11
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Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg 2020; 140:827-833. [PMID: 32157370 PMCID: PMC7244460 DOI: 10.1007/s00402-020-03394-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Computed tomography-based three-dimensional models may allow the accurate determination of the center of rotation, lateral and anterior femoral offsets, and the required implant size in total hip arthroplasty. In this cadaver study, the accuracy of anatomical reconstruction was evaluated using a three-dimensional planning tool. MATERIALS AND METHODS A total of eight hip arthroplasties were performed on four bilateral specimens. Based on a computed tomography scan, the position and size of the prosthesis were templated with respect to the anatomical conditions. RESULTS On average, all parameters were reconstructed to an accuracy of 4.5 mm and lie within the limits recommended in the literature. All prostheses were implanted with the templated size. CONCLUSIONS The exact anatomy of the patient and the required size and position of the prosthesis were precisely analyzed using a templating software. Based on the present findings, the development of template-directed instrumentation is conceivable using this method. However, further technical features (e.g., navigation or robot-assisted surgery) are required for improved precision for implant positioning.
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Affiliation(s)
- P. Savov
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Budde
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Tsamassiotis
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - H. Windhagen
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - M. Klintschar
- grid.10423.340000 0000 9529 9877Institute for Forensic Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, Germany
| | - M. Ettinger
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
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12
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Messer-Hannemann P, Bätz J, Lampe F, Klein A, Püschel K, Campbell GM, Morlock M. The influence of cavity preparation and press-fit cup implantation on restoring the hip rotation center. Clin Biomech (Bristol, Avon) 2019; 63:185-192. [PMID: 30913461 DOI: 10.1016/j.clinbiomech.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Reaming of the acetabular cavity and cup implantation directly influence the hip rotation center and contact area between implant and bone. Previous studies have reported on an altered rotation center after total hip arthroplasty, but have not studied the influence of reaming and cup implantation separately. Aim of this study was therefore to analyze the individual influence of acetabular reaming and subsequent cup implantation on the rotation center and how this influences the contact conditions at the bone-implant interface. METHODS Acetabular press-fit cups were implanted into the left and right hips of three full cadavers (n = 6). CT scans were performed to calculate the change in hip rotation center after reaming and prior to liner insertion. 3D models of the cups were used to determine the polar gap, the contact conditions and the effective press-fit. FINDINGS Reaming the acetabular cavity shifted the rotation center medially (median 5.8 mm, range 4.8-9.1), superiorly (5.3 mm, 3.0-7.0) and posteriorly (2.9 mm, 1.0-5.3). With cup implantation, the rotation center shifted back towards the native position, but no full restoration was observed. The degree of shift increased with the size of polar gap (rs = 0.829, P = .042), which inversely reduced the contact area (rs = 0.886, P = .019). INTERPRETATION This study reveals that the dominant factor in hip rotation center restoration is the reaming process, while the cup implantation for a given nominal press-fit has only a small influence. Increasing the press-fit would improve the restoration but bares the danger of insufficient bone coverage and periprosthetic fractures due to the high forces needed.
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Affiliation(s)
- Philipp Messer-Hannemann
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany.
| | - Johanna Bätz
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - Frank Lampe
- Hamburg University of Applied Sciences, Department of Life Sciences, Ulmenliet 20, 21033 Hamburg, Germany
| | - Anke Klein
- University Medical Center Hamburg-Eppendorf, Department of Legal Medicine, Butenfeld 34, 22529 Hamburg, Germany
| | - Klaus Püschel
- University Medical Center Hamburg-Eppendorf, Department of Legal Medicine, Butenfeld 34, 22529 Hamburg, Germany
| | - Graeme M Campbell
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
| | - Michael Morlock
- TUHH, Hamburg University of Technology, Institute of Biomechanics, Denickestrasse 15, 21073 Hamburg, Germany
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13
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Shao P, Li Z, Yang M, Wang Y, Liu T, Yang Y, Duan L, Jiang J, Zuo J. Impact of acetabular reaming depth on reconstruction of rotation center in primary total hip arthroplasty. BMC Musculoskelet Disord 2018; 19:425. [PMID: 30497444 PMCID: PMC6267806 DOI: 10.1186/s12891-018-2336-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 11/07/2018] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To study the impact of acetabular reaming depth on reconstruction of rotation center (RC) in unilateral primary total hip arthroplasty (UPTHA) and guide individualized preoperative design. METHODS 200 postoperative standard bilateral hip anteroposterior radiographs after UPTHA were included, which were collected from January, 2013 to June, 2017 in our hospital. Osteonecrosis of femoral head was the only diagnosis in this cohort. The parameters were measured on the anteropoterior radiographs by using RadiAnt DICOM viewer. RESULTS The average of the thickness of the teardrop is about 6.13 ± 1.42 mm. The parameter a (the difference value of the distance of bilateral RC and midline) was positively correlated with the parameter e (the acetabular reaming depth), and the Pearson correlation coefficient was 0.49 when P = 0.05. Furthermore, the value of parameter (e) was 8.25 mm when a2 (the distance from the center of the prosthesis femoral head to the vertical line across the midpoint of pubic symphysis) equaled a1 (the distance from RC of the healthy femoral head to the vertical line across the midpoint of pubic symphysis). CONCLUSIONS The reaming depth of the acetabulum could influence the reconstruction of RC during UPTHA. When the medial margin of the cup was placed about 2 mm to the lateral border of the ipsilateral teardrop (the bottom of the ovum), the rotation center would be accurately restored.
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Affiliation(s)
- Pu Shao
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Zhizhou Li
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Modi Yang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Yuzhuo Wang
- Department of Orthodontics, School and Hospital of Stomatology, Jilin University, Changchun, 130021, People's Republic of China
| | - Te Liu
- Scientific Research Centre of China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Yuhui Yang
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Lian Duan
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China
| | - Jinlan Jiang
- Scientific Research Centre of China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China.
| | - Jianlin Zuo
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, 126 xiantai street, Changchun, 130033, People's Republic of China.
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14
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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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15
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Rivière C, Lazic S, Villet L, Wiart Y, Allwood SM, Cobb J. Kinematic alignment technique for total hip and knee arthroplasty: The personalized implant positioning surgery. EFORT Open Rev 2018; 3:98-105. [PMID: 29657851 PMCID: PMC5890135 DOI: 10.1302/2058-5241.3.170022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Conventional techniques for hip and knee arthroplasty have led to good long-term clinical outcomes, but complications remain despite better surgical precision and improvements in implant design and quality. Technological improvements and a better understanding of joint kinematics have facilitated the progression to ‘personalized’ implant positioning (kinematic alignment) for total hip (THA) and knee (TKA) arthroplasty, the true value of which remains to be determined. By achieving a true knee resurfacing, the kinematic alignment (KA) technique for TKA aims at aligning the components with the physiological kinematic axes of the knee and restoring the constitutional tibio-femoral joint line frontal and axial orientation and soft-tissue laxity. The KA technique for THA aims at restoring the native ‘combined femoro-acetabular anteversion’ and the hip’s centre of rotation, and occasionally adjusting the cup position and design based on the assessment of the individual spine-hip relation. The key element for optimal prosthetic joint kinematics (hip or knee) is to reproduce the femoral anatomy. The transverse acetabular ligament (TAL) is the reference landmark to adjust the cup position.
Cite this article: EFORT Open Rev 2018;3:98-105. DOI: 10.1302/2058-5241.3.170022
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK; South West London Elective Orthopaedic Center, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Center, UK
| | | | - Yann Wiart
- Unfallchirurgie, Theresienkrankenhauss Mannheim, Germany
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16
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Shoji T, Yamasaki T, Izumi S, Murakami H, Mifuji K, Sawa M, Yasunaga Y, Adachi N, Ochi M. Factors affecting the potential for posterior bony impingement after total hip arthroplasty. Bone Joint J 2017; 99-B:1140-1146. [DOI: 10.1302/0301-620x.99b9.bjj-2016-1078.r2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 05/09/2017] [Indexed: 11/05/2022]
Abstract
Aims Our aim was to evaluate the radiographic characteristics of patients undergoing total hip arthroplasty (THA) for the potential of posterior bony impingement using CT simulations. Patients and Methods Virtual CT data from 112 patients who underwent THA were analysed. There were 40 men and 72 women. Their mean age was 59.1 years (41 to 76). Associations between radiographic characteristics and posterior bony impingement and the range of external rotation of the hip were evaluated. In addition, we investigated the effects of pelvic tilt and the neck/shaft angle and femoral offset on posterior bony impingement. Results The range of external rotation and the ischiofemoral length were significantly lower, while femoral anteversion, the ischial ratio, and ischial angle were significantly higher in patients with posterior bony impingement compared with those who had implant impingement (p < 0.05). The range of external rotation positively correlated with ischiofemoral length (r = 0.49, p < 0.05), and negatively correlated with ischial length (r = -0.49, p < 0.05), ischial ratio (r =- 0.49, p < 0.05) and ischial angle (r = -0.55, p < 0.05). The range of external rotation was lower in patients with posterior pelvic tilt (p < 0.05) and in those with a high offset femoral component (p < 0.05) due to posterior bony impingement. Conclusion Posterior bony impingement after THA is more likely in patients with a wider ischium and a narrow ischiofemoral space. A high femoral offset and posterior pelvic tilt are also risk factors for this type of impingement. Cite this article: Bone Joint J 2017;99-B:1140–6.
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Affiliation(s)
- T. Shoji
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - T. Yamasaki
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - S. Izumi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - H. Murakami
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - K. Mifuji
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Sawa
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - Y. Yasunaga
- Hiroshima Prefectural Rehabilitation Center, 295-3
Taguchi, Saijo-town, Higashi-hiroshima, 739-0036, Japan
| | - N. Adachi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
| | - M. Ochi
- Graduate School of Biomedical Sciences,
Hiroshima University,
1-2-3 Kasumi, Minami-ku, Hiroshima
734-8551, Japan
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17
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Rivière C, Lazennec JY, Van Der Straeten C, Auvinet E, Cobb J, Muirhead-Allwood S. The influence of spine-hip relations on total hip replacement: A systematic review. Orthop Traumatol Surg Res 2017; 103:559-568. [PMID: 28373138 DOI: 10.1016/j.otsr.2017.02.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 02/02/2023]
Abstract
Sagittal pelvic kinematics along with spino-pelvic angular parameters have recently been studied by numerous investigators for their effect on total hip replacement (THR) clinical outcomes, but many issue of spine-hip relations (SHR) are currently unexplored. Therefore, our review aims at clarifying the following questions: is there any evidence of a relationship between articular impingement/dislocation risk in primary THR and (1) certain sagittal pelvic kinematics patterns, (2) pelvic incidence, and (3) types of SHRs? A systematic review of the existing literature utilising PubMed and Google search engines was performed in January 2017. Only clinical or computational studies published in peer-reviewed journals over the last five years in either English or French were reviewed. We identified 769 reports, of which 12 met our eligibility criteria. A review of literature shows that sagittal pelvic kinematics, but not the pelvic incidence, influences the risk of prosthetic impingement/dislocation. We found no study having assessed the relationship between this risk and the types of SHRs. Sagittal pelvic kinematics is highly variable among individuals and certain kinematic patterns substantially influences the risk of prosthetic impingement/dislocation. Recommendations for cup positioning are therefore switching from a systematic to a patient-specific approach, with the standing cup orientation Lewinneck safe zone progressively giving way to a new parameter of interest: the functional orientation of the cup. Based on a recently published classification for SHRs, We propose a new concept of "kinematically aligned THR" for the purposes of THR planning. Further studies are needed to investigate the relevance of such a classification towards the assumptions and hypothesis we have made. Level of evidence,- Level IV, systematic review of level III and IV studies.
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Affiliation(s)
- C Rivière
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK.
| | - J-Y Lazennec
- Service de chirurgie orthopédique, hôpital Pitié-Salpêtrière, université Pierre-et-Marie-Curie, 47-83, boulevard de l'Hôpital, 75634 Paris cedex 13, France
| | - C Van Der Straeten
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - E Auvinet
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
| | - J Cobb
- MSK Lab, 7, Laboratory Block, Charing Cross Campus, Imperial college of London, W6 8RP London, UK
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18
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Meermans G, Doorn JV, Kats JJ. Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Joint J 2017; 98-B:1597-1603. [PMID: 27909120 DOI: 10.1302/0301-620x.98b12.bjj-2016-0345.r1] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 08/16/2016] [Indexed: 01/14/2023]
Abstract
AIMS One goal of total hip arthroplasty is to restore normal hip anatomy. The aim of this study was to compare displacement of the centre of rotation (COR) using a standard reaming technique with a technique in which the acetabulum was reamed immediately peripherally and referenced off the rim. PATIENTS AND METHODS In the first cohort the acetabulum was reamed to the floor followed by sequentially larger reamers. In the second cohort the acetabulum was only reamed peripherally, starting with a reamer the same size as the native femoral head. Anteroposterior pelvic radiographs were analysed for acetabular floor depth and vertical and horizontal position of the COR. RESULTS Horizontally, the mean medial displacement of the COR was 0.8 mm (standard deviation (sd) 1.4) in the peripheral remaing group and 5.0 mm (sd 3.30) in the standard reaming group (p < 0.001). Vertically, the mean superior displacement of the COR was 0.7 mm (sd 1.3) in the peripheral reaming group and 3.7 mm (sd 2.6) in the standard reaming group (p < 0.001). In the standard reaming group, there was a strong correlation between the pre-operative acetabular floor depth and displacement of the COR (p < 0.001). CONCLUSION Reaming the acetabulum to the floor can lead to significant displacement of the COR medially and superiorly. This displacement is related to the pre-operative acetabular floor depth and cannot always be compensated by using a high offset stem. Cite this article: Bone Joint J 2016;98-B:1597-603.
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Affiliation(s)
- G Meermans
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J Van Doorn
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
| | - J-J Kats
- Bravis Hospital, Boerhaaveplein 1, 4624VT Bergen op Zoom, The Netherlands
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Impact of individual anatomy on the benefit of cup medialisation in total hip arthroplasty. Hip Int 2016; 26:537-542. [PMID: 27739568 DOI: 10.5301/hipint.5000392] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In total hip arthroplasty, cup medialisation with compensatory increase of femoral offset has been proposed to increase the moment arms of abductor muscles. However, this technique is associated with a loss of acetabular bone stock. Previous data indicates that the potential benefit is not constant among patients and is likely related to patient anatomy. METHOD Therefore, to be able to select patients who would benefit most from this technique, we measured several anatomical parameters of the pelvis and femur in 15 patients; and evaluated correlations between them and the changes of moment arms associated with cup medialisation. The anatomical measurements were performed on 3-D reconstructions of preoperative CT scans. The moment arms of the gluteus medius and gluteus minimus were calculated for an abduction and flexion movement using patient-specific finite element models. RESULTS 6 anatomical parameters were correlated with muscle moment arm variations after cup medialisation. This effect was not systematic for either muscles or movements. Among all parameters, femoral anteversion was the most important parameter in explaining the effect of cup medialisation. DISCUSSION Patients with small femoral anteversion or low-riding greater trochanter benefit more from cup medialisation in terms of moment arm increase in abduction motion.
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Kobayashi H, Nakashima Y, Yamamoto T, Motomura G, Kanazawa M, Takagishi K, Iwamoto Y. Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty. Open Orthop J 2016; 10:206-12. [PMID: 27398108 PMCID: PMC4920972 DOI: 10.2174/1874325001610010206] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 05/17/2016] [Accepted: 05/19/2016] [Indexed: 12/02/2022] Open
Abstract
Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients.
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Affiliation(s)
- Hiroki Kobayashi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Goro Motomura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Masayuki Kanazawa
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
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Sariali E, Catonne Y, Pascal-Moussellard H. Three-dimensional planning-guided total hip arthroplasty through a minimally invasive direct anterior approach. Clinical outcomes at five years’ follow-up. INTERNATIONAL ORTHOPAEDICS 2016; 41:699-705. [DOI: 10.1007/s00264-016-3242-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/05/2016] [Indexed: 02/06/2023]
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Durand-Hill M, Henckel J, Satchithananda K, Sabah S, Hua J, Hothi H, Langstaff RJ, Skinner J, Hart A. Calculating the hip center of rotation using contralateral pelvic anatomy. J Orthop Res 2016; 34:1077-83. [PMID: 26630078 DOI: 10.1002/jor.23118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/25/2015] [Indexed: 02/04/2023]
Abstract
Failure to place an artificial hip in the optimal center of rotation results in poor hip function and costly complications. The aim of this study was to develop robust methodology to estimate hip center of rotation (hCoR) from preoperative computed tomography (CT) scans, using contralateral anatomy, in patients with unilateral diseased hips. Ten patients (five male, five female) with normal pelvic anatomy, and one patient with a unilateral dysplastic acetabulum were recruited from the London Implant Retrieval center image bank. 3D models of each pelvis were generated using commercial software. Two methods for estimation of hCoR were compared. Method 1 used a mirroring technique alone. Method 2 utilized mirroring and automatic alignment. Predicted versus actual hCoR co-ordinates were compared using intraclass correlation coefficients and paired T-tests. Both methods predicted hCoR with excellent agreement to original co-ordinates (>0.9) in all axes. Both techniques allowed prediction of the hCoR within ± 5 mm in all axes. Both techniques provided useful clinical information for planning acetabular reconstruction in patients with unilateral defects. Method 1 was less complex and is suitable for patients with developmental and degenerative pathologies. Method 2 may provide greater accuracy in a discrete group of patients with normal development prior to pathology (e.g., acetabular fractures). © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1077-1083, 2016.
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Affiliation(s)
- Matthieu Durand-Hill
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Johann Henckel
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Keshthra Satchithananda
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Shiraz Sabah
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Jia Hua
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Harry Hothi
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | | | - John Skinner
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
| | - Alister Hart
- Institute of Orthopaedic and Musculoskeletal Science, University College London, London, United Kingdom
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Tansey P. Hip and low back pain in the presence of femoral anteversion. A case report. ACTA ACUST UNITED AC 2015; 20:206-11. [DOI: 10.1016/j.math.2014.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Paula Tansey
- Physiotherapy Department, Connolly Hospital, Blanchardstown, Dublin 15, Ireland.
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Sariali E, Klouche S, Mouttet A, Pascal-Moussellard H. The effect of femoral offset modification on gait after total hip arthroplasty. Acta Orthop 2014; 85:123-7. [PMID: 24564749 PMCID: PMC3967252 DOI: 10.3109/17453674.2014.889980] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [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 A decrease of 15% in femoral offset (FO) has been reported to generate a weakness of the abductor muscle, but this has not been directly linked to an alteration of gait. Our hypothesis was that this 15% decrease in FO may also generate a clinically detectable alteration in the gait. PATIENTS AND METHODS We performed a prospective comparative study on 28 patients who underwent total hip arthroplasty (THA) for unilateral primary osteoarthritis. The 3D hip anatomy was analyzed preoperatively and postoperatively. 3 groups were defined according to the alteration in FO following surgery: a minimum decrease of 15% (9 patients), restored (14), and a minimum increase of 15% (5). A gait analysis was performed at 1-year follow-up using an ambulatory device. Each limb was compared to the contralateral healthy limb. RESULTS In contrast to the "restored" group and the "increased" group, in the "decreased" group there was a statistically significant asymmetry between sides, with reduced range of motion and a lower maximal swing speed on the operated side. INTERPRETATION A decrease in FO of 15% or more after THA leads to an alteration in the gait. We recommend 3-D preoperative planning because the FO may be underestimated by up to 20% on radiographs and it may therefore not be restored, with clinical consequences.
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Eilander W, Harris SJ, Henkus HE, Cobb JP, Hogervorst T. Functional acetabular component position with supine total hip replacement. Bone Joint J 2013; 95-B:1326-31. [DOI: 10.1302/0301-620x.95b10.31446] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Orientation of the acetabular component influences wear, range of movement and the incidence of dislocation after total hip replacement (THR). During surgery, such orientation is often referenced to the anterior pelvic plane (APP), but APP inclination relative to the coronal plane (pelvic tilt) varies substantially between individuals. In contrast, the change in pelvic tilt from supine to standing (dPT) is small for nearly all individuals. Therefore, in THR performed with the patient supine and the patient’s coronal plane parallel to the operating table, we propose that freehand placement of the acetabular component placement is reliable and reflects standing (functional) cup position. We examined this hypothesis in 56 hips in 56 patients (19 men) with a mean age of 61 years (29 to 80) using three-dimensional CT pelvic reconstructions and standing lateral pelvic radiographs. We found a low variability of acetabular component placement, with 46 implants (82%) placed within a combined range of 30° to 50° inclination and 5° to 25° anteversion. Changing from the supine to the standing position (analysed in 47 patients) was associated with an anteversion change < 10° in 45 patients (96%). dPT was < 10° in 41 patients (87%). In conclusion, supine THR appears to provide reliable freehand acetabular component placement. In most patients a small reclination of the pelvis going from supine to standing causes a small increase in anteversion of the acetabular component. Cite this article: Bone Joint J 2013;95-B:1326–31.
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Affiliation(s)
- W. Eilander
- Haga Hospital, Sportlaan
600 2566MJ, The Hague, the
Netherlands
| | - S. J. Harris
- Imperial College, Charing
Cross Campus, Fulham Palace Road, London
W6 8RF, UK
| | - H. E. Henkus
- Haga Hospital, Sportlaan
600 2566MJ, The Hague, the
Netherlands
| | - J. P. Cobb
- Imperial College, Charing
Cross Campus, Fulham Palace Road, London
W6 8RF, UK
| | - T. Hogervorst
- Haga Hospital, Sportlaan
600 2566MJ, The Hague, the
Netherlands
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Sato T, Nakashima Y, Matsushita A, Fujii M, Iwamoto Y. Effects of posterior pelvic tilt on anterior instability in total hip arthroplasty: a parametric experimental modeling evaluation. Clin Biomech (Bristol, Avon) 2013; 28:178-81. [PMID: 23312621 DOI: 10.1016/j.clinbiomech.2012.12.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/14/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
Abstract
BACKGROUND Anterior dislocation is one of the concerns of patients with posterior pelvic tilt undergoing total hip arthroplasty. This study aimed to evaluate the magnitude of posterior pelvic tilt constituting a risk for anterior dislocation by measuring the range of motion until impingement and dislocation under various pelvic tilt. METHODS Using a jig mounted prosthetic hip model, the ranges of external rotation at extension and internal rotation at flexion until reaching dislocation were tested. The site of impingement prior to dislocation was also recorded. Posterior pelvic tilt and the cup version were changed with 10° increments from 0° to 40° and from 10° retroversion to 30° anteversion, respectively. Effects of increasing femoral offset were also tested. We defined a required range of motion as having 30° external rotation at extension and 40° internal rotation at 90° flexion. FINDINGS External rotation decreased in a posterior pelvic tilt-dependent manner. In the case with more than 20° posterior pelvic tilt, available external rotation extended beyond required range with the cup anteversion of 20°. Decreasing cup anteversion improved external rotation, however, internal rotation decreased simultaneously. In the case with posterior pelvic tilt more than 20°, only cup anteversion with 0° or 10° satisfied the required range of motion. A +4 mm horizontal offset improved external rotation by 10° with delaying bony impingement. INTERPRETATION More than 20° of posterior pelvic tilt may cause anterior instability and diminish the optimal range of cup version. Increasing the femoral offset improved external rotation without reducing internal rotation.
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Affiliation(s)
- Taishi Sato
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi Higashi-ku Fukuoka 812-8582, Japan
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