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Lunn DE, Redmond AC, Chapman GJ, Lund ME, Ferguson SJ, De Pieri E. Hip contact force pathways in total hip replacement differ between patients and activities of daily living. J Biomech 2024; 176:112309. [PMID: 39260233 DOI: 10.1016/j.jbiomech.2024.112309] [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: 03/01/2024] [Revised: 09/05/2024] [Accepted: 09/05/2024] [Indexed: 09/13/2024]
Abstract
One of the main causes of implant failure and revision surgery in total hip replacement (THR) is aseptic loosening often caused by the accumulation of wear debris arising between the contact surfaces of the acetabular cup and femoral head during activities of daily living (ADL's). However, limited information is available regarding the contact force pathways between these two surfaces during specific ADL's. In this study, through musculoskeletal modelling, we aimed to estimate the orientation of the hip contact force pathway on the acetabular cup. One hundred and thirty-two THR patients underwent motion capture analysis whilst undertaking locomotor and non-locomotor ADL's. Musculoskeletal simulations were performed to calculate contact force pathways using inverse dynamics analysis. We then qualitatively compared differences in the contact force pathways between patients and between ADL's. Walking resulted in a typical figure-of-eight pattern, with the peak contact forces occurring in the superior-anterior area of the cup. The non-locomotive activities such as stand up, sit down and squat had a more linear shape, spanning across the superior-posterior quarter of the cup. Our results showed a large inter-patient variability in the shape and location of the contact force pathway. There is a distinct difference in the location and shape of the pathway between locomotor and non-locomotor activities and this could result in different wear accumulations. These results could enhance our understanding why revision rates vary across the population and could inform the development of personalised implant design.
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Affiliation(s)
- David E Lunn
- Carnegie School of Sport, Leeds Beckett University, Leeds, UK; NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - Anthony C Redmond
- NIHR Leeds Biomedical Research Centre, Leeds, UK; Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
| | - Graham J Chapman
- Allied Health Research Unit, University of Central Lancashire, Preston, UK.
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2
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Döring J, Bormann T, Buchholz A, Hembus J, Rothammer B, Uhler M. [Tribology in arthroplasty : Friction and wear, a key to a long lifetime]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:479-486. [PMID: 38833160 DOI: 10.1007/s00132-024-04520-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/06/2024]
Abstract
This article is intended to highlight one of the key roles in endoprosthetic treatment with artificial implants and the extension of service life. Like every joint, artificial joints are subject to the physical laws of friction and wear-in short, tribology. Material pairings, surfaces and mechanisms of action in particular play a decisive role here. The special features and current findings relating to the three largest synovial joints (hip, knee and shoulder) will be discussed in detail and suggestions will be made for future developments. Continuous developments in the field of the tribology of artificial joints can massively improve care for patients. The revision figures and reasons already show the success of individual improvements in recent years.
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Affiliation(s)
- Joachim Döring
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Therese Bormann
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
| | - Adrian Buchholz
- Orthopädische Universitätsklinik, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Jessica Hembus
- Forschungslabor für Biomechanik und Implantattechnologie, Orthopädische Klinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
| | - Benedict Rothammer
- Lehrstuhl für Konstruktionstechnik, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Maximilian Uhler
- Sektion für Biomechanik und Implantatforschung, Klinik für Orthopädie, Universitätsklinikums Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Deutschland
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3
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Wong Z, Jordan LA, Saluja A, Spaan J, Su E. Correction of Acquired Leg Length Discrepancy after Hip Resurfacing Arthroplasty by Revision Resurfacing: A Case Report. JBJS Case Connect 2024; 14:01709767-202409000-00039. [PMID: 39208141 DOI: 10.2106/jbjs.cc.23.00647] [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: 09/04/2024]
Abstract
CASE A 53-year-old man presented with a 13-mm leg length discrepancy following left hip resurfacing arthroplasty (HRA), resulting in pain and imbalance. Advanced osteoarthritis of the contralateral hip was also noted. The patient strongly preferred HRA over total hip arthroplasty. Adequate remaining bone stock and the ability to resurface the contralateral hip allowed for resolution with 2 HRAs. CONCLUSION This is the first known revision of a HRA with a subsequent HRA. Assuming sufficient bone stock and precise implant positioning, resurfacing presents a feasible methodology to overcome complex anatomical deformities and improve mobility.
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Affiliation(s)
- Zachary Wong
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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4
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Di Martino A, Geraci G, Brunello M, D'Agostino C, Davico G, Curreli C, Traina F, Faldini C. Hip-spine relationship: clinical evidence and biomechanical issues. Arch Orthop Trauma Surg 2024; 144:1821-1833. [PMID: 38472450 PMCID: PMC10965652 DOI: 10.1007/s00402-024-05227-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024]
Abstract
The hip-spine relationship is a critical consideration in total hip arthroplasty (THA) procedures. While THA is generally successful in patient, complications such as instability and dislocation can arise. These issues are significantly influenced by the alignment of implant components and the overall balance of the spine and pelvis, known as spinopelvic balance. Patients with alteration of those parameters, in particular rigid spines, often due to fusion surgery, face a higher risk of THA complications, with an emphasis on complications in instability, impingement and dislocation. For these reasons, over the years, computer modelling and simulation techniques have been developed to support clinicians in the different steps of surgery. The aim of the current review is to present current knowledge on hip-spine relationship to serve as a common platform of discussion among clinicians and engineers. The offered overview aims to update the reader on the main critical aspects of the issue, from both a theoretical and practical perspective, and to be a valuable introductory tool for those approaching this problem for the first time.
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Affiliation(s)
- Alberto Di Martino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy.
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy.
| | - Giuseppe Geraci
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Matteo Brunello
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Claudio D'Agostino
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
| | - Giorgio Davico
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Industrial Engineering, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Cristina Curreli
- Medical Technology Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francesco Traina
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti di Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Ist Orthopaedic Department, IRCCS-Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli, 1, 40136, Bologna, Italy
- Department of Biomedical and Neuromotor Science-DIBINEM, University of Bologna, 40136, Bologna, Italy
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Oxblom A, Hedlund H, Itayem R, Felländer-Tsai L, Vidgren M, Rolfson O, Brismar H. Careful patient selection together with optimal implant positioning may reduce but does not eliminate the risk of elevated serum cobalt and chrome levels following metal-on-metal hip resurfacing. Hip Int 2023; 33:872-879. [PMID: 36314413 PMCID: PMC10486161 DOI: 10.1177/11207000221124302] [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: 02/02/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Elevated serum chrome (sCr) and cobalt (sCo) concentrations are associated with local tissue adverse reactions to metal debris following metal-on-metal hip resurfacing (MoM-HR). Serum metal ions <2 µg/l are probably of little clinical relevance and a pragmatic "safe" threshold <5 µg/l has been suggested.The primary aim of this study was to evaluate if a careful selection of patients combined with optimal implant positioning could eliminate cases with "unsafe" serum metal ion levels. A secondary aim was to study the association between different risk factors and having Co and/or Cr levels >5 µg/l. PATIENTS AND METHODS This is a retrospective, single-institution cohort study of 410 consecutive patients operated on with a Birmingham Hip Resurfacing (BHR) implant between 2001 and 2014. 288 of these had a unilateral MoM-HR, pelvic and true lateral radiographs, and a related sCo and sCr sample, and were included in the final analysis. They were allocated to either a presumed "optimal group" consisting of only men aged <60 years old, with femoral head component >48 mm diameter, and with a cup positioned within Lewinnek's safe zones, or a "suboptimal group" consisting of the remaining patients. Fisher's exact test and multiple logistic regression analyses were performed. RESULTS In the optimal group 48% (47/97) had serum metal ions >2 µg/l and 8% (8/97) >5 µg/l compared to 61% (116/191) and 18% (34/191) in the suboptimal group, p = 0.059 and p = 0.034 respectively. Acetabular cups with an anteversion <5 degrees had the highest odds ratio, 6.5 (95% CI, 3.0-14.3), of having sCo and sCr concentrations exceeding 5 µg/l. CONCLUSIONS A well oriented BHR acetabular component in a presumably "optimal" patient reduces the risk of having elevated serum metal ions but does not eliminate it. Insufficient cup anteversion seems to be the strongest associated factor of elevated serum metals.
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Affiliation(s)
- Alexander Oxblom
- Division of Orthopaedics and Biotechnology, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, VO KOU, Sodertalje Hospital, Sodertalje, Sweden
| | - Håkan Hedlund
- Division of Orthopaedics and Biotechnology, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Department of Orthopaedics, Visby Hospital, Visby, Sweden
| | - Raed Itayem
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sweden
| | - Li Felländer-Tsai
- Division of Orthopaedics and Biotechnology, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
| | - Mathias Vidgren
- Division of Orthopaedics and Biotechnology, CLINTEC, Karolinska Institute, Stockholm, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy University of Gothenburg, Sweden
| | - Harald Brismar
- Division of Orthopaedics and Biotechnology, CLINTEC, Karolinska Institute, Stockholm, Sweden
- Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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6
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Samuel LT, Zuke WA, Mahmood S, Munim MA, Alamir PB, Brooks PJ. Hip Resurfacing: A Single Surgeon U.S. Series With Minimum Ten-Year Follow-up. J Arthroplasty 2022; 37:1799-1808. [PMID: 35429614 DOI: 10.1016/j.arth.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/14/2022] [Accepted: 04/08/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Metal-on-metal hip resurfacing is an alternative to total hip arthroplasty (THA). The aim of this study was to determine implant survivorship, analyze patient-reported outcomes measures and to determine patient satisfaction for patients who underwent metal-on-metal hip resurfacing at a large US academic institution by a single surgeon with a minimum of 10-year follow-up. METHODS Patients who underwent hip resurfacing from September 2006 through November 2009 were included. Patient demographics and variables were collected from a prospectively maintained institutional database and patients completed an additional questionnaire with patient-reported outcomes measures. RESULTS A total of 350 patients (389 hips) out of 371 (433 hips) with a minimum 10-year follow-up were successfully contacted (94.3% follow-up). Mean age was 53 years, 258 were male (73%). 377 out of 389 hips (96.9%) did not require additional surgery. Gender was significantly related to implant survivorship (males 99.0%, females 90.9%; P < .001). 330 patients (369 hips, 94.8%) were satisfied with their surgery. Males had higher proportion of satisfaction scores (P = .02) and higher modified Harris Hip Score (odds ratio = 2.63 (1.39, 4.98), P = .003). Median modified Harris Hip Score score for non-revised hips was 84.0 [80.0; 86.0] versus those requiring revision, 81.5 [74.0; 83.0], (P = .009). CONCLUSION At a minimum 10-year follow-up, hip resurfacing, using an implant with a good track record, demonstrates 99.0% survivorship in male patients with an average age of 52 years. We believe that the continued use of metal-on-metal hip resurfacing arthroplasty in this population is justified by both positive patient reported outcomes and survivorship.
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Affiliation(s)
- Linsen T Samuel
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - William A Zuke
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Sania Mahmood
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Mohammed A Munim
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Peter J Brooks
- Department of Orthopaedic Surgery, Orthopaedic & Rheumatological Institute, Cleveland Clinic Foundation, Cleveland, Ohio
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7
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Danaei B, McPhee J. Model-Based Acetabular Cup Orientation Optimization Based On Minimizing the Risk of Edge-Loading and Implant Impingement Following Total Hip Arthroplasty. J Biomech Eng 2022; 144:1141865. [PMID: 35748611 DOI: 10.1115/1.4054866] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Indexed: 11/08/2022]
Abstract
In this paper, a computationally-efficient model-based method for determining patient-specific optimal acetabular cup alignment for total hip arthroplasty (THA) is presented. The proposed algorithm minimizes the risk of implant impingement and edge-loading, which are reported as the major causes of hip dislocation following THA. First, by using motion capture data recorded from the patient performing different daily activities, the hip contact force and the relative orientation of the femur and pelvis are calculated by a musculoskeletal model. Then, by defining two quantitative indices i.e., angular impingement distance and angular edge-loading distance, the risk of impingement and edge-loading are assessed for a wide range of cup alignments. And finally, three optimization criteria are introduced to estimate the optimal cup alignment with a tradeoff between the risk of impingement and edge-loading. The results show that patient-specific characteristics such as pelvic tilt could significantly change the optimal cup alignment, especially the value of cup anteversion. Therefore, in some cases, the well-known Lewinnek safe zone may not be optimal, or even safe. Unlike other dynamic model-based methods, in this work, the need for force plate measurements is eliminated by estimating the ground reaction forces and moments, which makes this method more practical and cost-efficient. Furthermore, the low computational complexity due to analytical formulas makes this method suitable for both preoperative and intra-operative planning.
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Affiliation(s)
- Behzad Danaei
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - John McPhee
- Motion Research Group, Department of Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
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8
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Habor J, Fischer MCM, Tokunaga K, Okamoto M, Radermacher K. The Patient-Specific Combined Target Zone for Morpho-Functional Planning of Total Hip Arthroplasty. J Pers Med 2021; 11:jpm11080817. [PMID: 34442461 PMCID: PMC8402039 DOI: 10.3390/jpm11080817] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Relevant criteria for total hip arthroplasty (THA) planning have been introduced in the literature which include the hip range of motion, bony coverage, anterior cup overhang, leg length discrepancy, edge loading risk, and wear. The optimal implant design and alignment depends on the patient’s anatomy and patient-specific functional parameters such as the pelvic tilt. The approaches proposed in literature often consider one or more criteria for THA planning. but to the best of our knowledge none of them follow an integrated approach including all criteria for the definition of a patient-specific combined target zone (PSCTZ). Questions/purposes (1) How can we calculate suitable THA implant and implantation parameters for a specific patient considering all relevant criteria? (2) Are the resulting target zones in the range of conventional safe zones? (3) Do patients who fulfil these combined criteria have a better outcome score? Methods A method is presented that calculates individual target zones based on the morphology, range of motion and load acting on the hip joint and merges them into the PSCTZ. In a retrospective analysis of 198 THA patients, it was calculated whether the patients were inside or outside the Lewinnek safe zone, Dorr combined anteversion range and PSCTZ. The postoperative Harris Hip Scores (HHS) between insiders and outsiders were compared. Results 11 patients were inside the PSCTZ. Patients inside and outside the PSCTZ showed no significant difference in the HHS. However, a significant higher HHS was observed for the insiders of two of the three sub-target zones incorporated in the PSCTZ. By combining the sub-target zones in the PSCTZ, all PSCTZ insiders except one had an HHS higher than 90. Conclusions The results might suggest that, for a prosthesis implanted in the PSCTZ a low outcome score of the patient is less likely than using the conventional safe zones by Lewinnek and Dorr. For future studies, a larger cohort of patients inside the PSCTZ is needed which can only be achieved if the cases are planned prospectively with the method introduced in this paper. Clinical Relevance The method presented in this paper could help the surgeon combining multiple different criteria during THA planning and find the suitable implant design and alignment for a specific patient.
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Affiliation(s)
- Juliana Habor
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Maximilian C. M. Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
| | - Kunihiko Tokunaga
- Niigata Hip Joint Center, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Masashi Okamoto
- Department of Radiology, Kameda Daiichi Hospital, Niigata City 950-0165, Japan;
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, 52074 Aachen, Germany; (J.H.); (M.C.M.F.)
- Correspondence:
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Song K, Pascual-Garrido C, Clohisy JC, Harris MD. Acetabular Edge Loading During Gait Is Elevated by the Anatomical Deformities of Hip Dysplasia. Front Sports Act Living 2021; 3:687419. [PMID: 34278299 PMCID: PMC8281296 DOI: 10.3389/fspor.2021.687419] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
Developmental dysplasia of the hip (DDH) is a known risk factor for articular tissue damage and secondary hip osteoarthritis. Acetabular labral tears are prevalent in hips with DDH and may result from excessive loading at the edge of the shallow acetabulum. Location-specific risks for labral tears may also depend on neuromuscular factors such as movement patterns and muscle-induced hip joint reaction forces (JRFs). To evaluate such mechanically-induced risks, we used subject-specific musculoskeletal models to compare acetabular edge loading (AEL) during gait between individuals with DDH (N = 15) and healthy controls (N = 15), and determined the associations between AEL and radiographic measures of DDH acetabular anatomy. The three-dimensional pelvis and femur anatomy of each DDH and control subject were reconstructed from magnetic resonance images and used to personalize hip joint center locations and muscle paths in each model. Model-estimated hip JRFs were projected onto the three-dimensional acetabular rim to predict instantaneous AEL forces and their accumulative impulses throughout a gait cycle. Compared to controls, subjects with DDH demonstrated significantly higher AEL in the antero-superior acetabulum during early stance (3.6 vs. 2.8 × BW, p ≤ 0.01), late stance (4.3 vs. 3.3 × BW, p ≤ 0.05), and throughout the gait cycle (1.8 vs. 1.4 × BW*s, p ≤ 0.02), despite having similar hip movement patterns. Elevated AEL primarily occurred in regions where the shallow acetabular edge was in close proximity to the hip JRF direction, and was strongly correlated with the radiographic severity of acetabular deformities. The results suggest AEL is highly dependent on movement and muscle-induced joint loading, and significantly elevated by the DDH acetabular deformities.
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Affiliation(s)
- Ke Song
- Program in Physical Therapy, Movement Science Research Center, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States
| | - Cecilia Pascual-Garrido
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - John C Clohisy
- Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Michael D Harris
- Program in Physical Therapy, Movement Science Research Center, Washington University in St. Louis School of Medicine, St. Louis, MO, United States.,Department of Mechanical Engineering and Materials Science, Washington University in St. Louis, St. Louis, MO, United States.,Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
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10
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Bourget-Murray J, Taneja A, Naserkhaki S, El-Rich M, Adeeb S, Powell J, Johnston K. Computational modelling of hip resurfacing arthroplasty investigating the effect of femoral version on hip biomechanics. PLoS One 2021; 16:e0252435. [PMID: 34043721 PMCID: PMC8158908 DOI: 10.1371/journal.pone.0252435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 05/15/2021] [Indexed: 11/18/2022] Open
Abstract
Aim How reduced femoral neck anteversion alters the distribution of pressure and contact area in Hip Resurfacing Arthroplasty (HRA) remains unclear. The purpose of this study was to quantitatively describe the biomechanical implication of different femoral neck version angles on HRA using a finite element analysis. Materials and methods A total of sixty models were constructed to assess the effect of different femoral neck version angles on three different functional loads: 0°of hip flexion, 45°of hip flexion, and 90° of hip flexion. Femoral version was varied between 30° of anteversion to 30° of retroversion. All models were tested with the acetabular cup in four different positions: (1) 40°/15° (inclination/version), (2) 40°/25°, (3) 50°/15°, and (4) 50°/25°. Differences in range of motion due to presence of impingement, joint contact pressure, and joint contact area with different femoral versions and acetabular cup positions were calculated. Results Impingement was found to be most significant with the femur in 30° of retroversion, regardless of acetabular cup position. Anterior hip impingement occurred earlier during hip flexion as the femur was progressively retroverted. Impingement was reduced in all models by increasing acetabular cup inclination and anteversion, yet this consequentially led to higher contact pressures. At 90° of hip flexion, contact pressures and contact areas were inversely related and showed most notable change with 30° of femoral retroversion. In this model, the contact area migrated towards the anterior implant-bone interface along the femoral neck. Conclusion Femoral retroversion in HRA influences impingement and increases joint contact pressure most when the hip is loaded in flexion. Increasing acetabular inclination decreases the area of impingement but doing so causes a reciprocal increase in joint contact pressure. It may be advisable to study femoral neck version pre-operatively to better choose hip resurfacing arthroplasty candidates.
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Affiliation(s)
- Jonathan Bourget-Murray
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, Canada
- * E-mail:
| | - Ashish Taneja
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Sadegh Naserkhaki
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Marwan El-Rich
- Department of Civil and Environmental Engineering University of Alberta, Edmonton, Alberta, Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering University of Alberta, Edmonton, Alberta, Canada
| | - James Powell
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, Canada
| | - Kelly Johnston
- Department of Surgery, Section of Orthopaedic Surgery, University of Calgary, Calgary, Canada
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11
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Belzunce MA, Henckel J, Di Laura A, Hart A. Uncemented femoral stem orientation and position in total hip arthroplasty: A CT study. J Orthop Res 2020; 38:1486-1496. [PMID: 32056292 DOI: 10.1002/jor.24627] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/09/2020] [Accepted: 02/11/2020] [Indexed: 02/04/2023]
Abstract
In total hip arthroplasty (THA), accurate positioning of components is important for the functionality and long life of the implant. Femoral component version has been underinvestigated when compared with the acetabular cup. Accurate prediction of the femoral version on the preoperative plan is particularly important because a well-fitting uncemented stem will, by definition, press-fit into a version that is dictated by the anatomy of the proximal femur. A better understanding of this has recently become an unmet need because of the increased use of uncemented stems and of preoperative image-based planning. We present the first, three-dimensional (3D) comparison between the planned and achieved orientation and position of the femoral components in THA. We propose a comparison method that uses the 3D models of a, computed tomography-generated (CT-generated), preoperative plan and a postoperative CT to obtain the discrepancy in the six possible degrees of freedom. We ran a prospective study (level 2 evidence) of 30 patients undergoing uncemented THA to quantify the discrepancy between planned and achieved femoral stem orientation and position. The discrepancy was low for femoral stem vertical position and leg length, and varus-valgus and anterior-posterior orientation. The discrepancy was higher for femoral version with a mean (±SD) of -1.5 ± 7.8 deg. Surgeons should be aware of the variability of the eventual position of uncemented stems in THA and acknowledge the risk of achieving a less-than-optimal femoral version, different from the preoperative 3D CT plan.
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Affiliation(s)
- Martin A Belzunce
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Johann Henckel
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Anna Di Laura
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Alister Hart
- Institute of Orthopaedics, Royal National Orthopaedic Hospital, Stanmore, UK.,Institute of Orthopaedics and Musculoskeletal Science, University College London, Stanmore, UK
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Modern cup alignment techniques in total hip arthroplasty: A systematic review. Orthop Traumatol Surg Res 2019; 105:907-913. [PMID: 31054840 DOI: 10.1016/j.otsr.2019.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 03/05/2019] [Accepted: 03/14/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A systematic review was conducted to assess the clinical and radiological outcomes of the alternative surgical techniques that consider the dynamic aspect of the acetabular orientation when aligning a cup (pelvic tilt-, lumbo-pelvic kinematics-, and spine-hip relationship-adjusted cup alignment techniques). METHOD Eight eligible articles reported the outcomes of total hip arthroplasty (THA) performed with alternative techniques. Clinical and radiological data were extracted. One study had a control group of patients who underwent conventional THAs (level III) while the seven other studies were level IV. Computer navigation system (CAS), Optimized Positioning System (OPS™), and manual instrumentation were used to align components in four, two, and two studies, respectively. A meta-analysis was not carried out because there was a lack of homogeneity between included articles regarding the method to position the cup and the nature of the reported data. RESULTS THA performed with alternative techniques had an early dislocation rate ranging from 0 to 1.9%, no unexpected catastrophic failure, and acceptable radiographic cup orientations. One study compared kinematically and mechanically aligned THAs and found no dislocation in either groups, similar patient reported outcome measures (43 Oxford-12 Score for both groups), and similar proportions of cup in the Lewinnek zone (respectively 65% and 70%). DISCUSSION/CONCLUSION Alternative methods accounting for the functional acetabular orientation seem to be clinically safe and effective in the early-term, and generate acceptable cup orientation on radiographs. Their values compare to those of more conventional techniques for cup implantation remain to be determined. We developed a classification of the multiple methods for aligning an acetabular component. LEVEL OF EVIDENCE IV, systematic review of level III and IV studies.
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Can an Augmented Reality Headset Improve Accuracy of Acetabular Cup Orientation in Simulated THA? A Randomized Trial. Clin Orthop Relat Res 2019; 477:1190-1199. [PMID: 30507832 PMCID: PMC6494316 DOI: 10.1097/corr.0000000000000542] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accurate implant orientation reduces wear and increases stability in arthroplasty but is a technically demanding skill. Augmented reality (AR) headsets overlay digital information on top of the real world. We have developed an enhanced AR headset capable of tracking bony anatomy in relation to an implant, but it has not yet been assessed for its suitability as a training tool for implant orientation. QUESTIONS/PURPOSES (1) In the setting of simulated THA performed by novices, does an AR headset improve the accuracy of acetabular component positioning compared with hands-on training by an expert surgeon? (2) What are trainees' perceptions of the AR headset in terms of realism of the task, acceptability of the technology, and its potential role for surgical training? METHODS Twenty-four study participants (medical students in their final year of school, who were applying to surgery residency programs, and who had no prior arthroplasty experience) participated in a randomized simulation trial using an AR headset and a simulated THA. Participants were randomized to two groups completing four once-weekly sessions of baseline assessment, training, and reassessment. One group trained using AR (with live holographic orientation feedback) and the other received one-on-one training from a hip arthroplasty surgeon. Demographics and baseline performance in orienting an acetabular implant to six patient-specific values on the phantom pelvis were collected before training and were comparable. The orientation error in degrees between the planned and achieved orientations was measured and was not different between groups with the numbers available (surgeon group mean error ± SD 16° ± 7° versus AR 14° ± 7°; p = 0.22). Participants trained by AR also completed a validated posttraining questionnaire evaluating their experiences. RESULTS During the four training sessions, participants using AR-guidance had smaller mean (± SD) errors in orientation than those receiving guidance from the surgeon: 1° ± 1° versus AR 6° ± 4°, p < 0.001. In the fourth session's assessment, participants in both groups had improved (surgeon group mean improvement 6°, 95% CI, 4-8°; p < 0.001 versus AR group 9°, 95% CI 7-10°; p < 0.001). There was no difference between participants in the surgeon-trained and AR-trained group: mean difference 1.2°, 95% CI, -1.8 to 4.2°; p = 0.281. In posttraining evaluation, 11 of 12 participants would use the AR platform as a training tool for developing visuospatial skills and 10 of 12 for procedure-specific rehearsals. Most participants (11 of 12) stated that a combination of an expert trainer for learning and AR for unsupervised training would be preferred. CONCLUSIONS A novel head-mounted AR platform tracked an implant in relation to bony anatomy to a clinically relevant level of accuracy during simulated THA. Learners were equally accurate, whether trained by AR or a surgeon. The platform enabled the use of real instruments and gave live feedback; AR was thus considered a feasible and valuable training tool as an adjunct to expert guidance in the operating room. Although there were no differences in accuracy between the groups trained using AR and those trained by an expert surgeon, we believe the tool may be useful in education because it demonstrates that some motor skills for arthroplasty may be learned in an unsupervised setting. Future studies will evaluate AR-training for arthroplasty skills other than cup orientation and its transfer validity to real surgery. LEVEL OF EVIDENCE Level I, therapeutic study.
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14
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Palit A, King R, Gu Y, Pierrepont J, Simpson D, Williams MA. Subject-Specific Surgical Planning for Hip Replacement: A Novel 2D Graphical Representation of 3D Hip Motion and Prosthetic Impingement Information. Ann Biomed Eng 2019; 47:1642-1656. [PMID: 30972601 PMCID: PMC6542782 DOI: 10.1007/s10439-019-02260-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/29/2019] [Indexed: 11/29/2022]
Abstract
Prosthetic impingement (PI) following total hip arthroplasty (THA), which arises due to the undesirable relative motion of the implants, results in adverse outcomes. Predicting PI through 3D graphical representation is difficult to comprehend when all activities are combined for different implant positions. Therefore, the aim of the paper was to translate this 3D information into a 2D graphical representation for improved understanding of the patient’s hip motion. The method used planned implanted geometry, positioned onto native bone anatomy, and activity definitions as inputs to construct the 2D polar plot from 3D hip motion in four steps. Three case studies were performed to highlight its potential use in (a) combining different activities in a single plot, (b) visualising the effect of different cup positions and (c) pelvic tilt on PI. A clinical study with 20 ‘Non-Dislocators’ and 20 ‘Dislocators’ patients after 2 years of THA was performed to validate the method. The results supported the study hypothesis, in that the incidence of PI was always higher in the ‘Dislocators’ compared to the ‘Non-Dislocators’ group. The proposed 2D graphical representation could assist in subject-specific THA planning by visualising the effect of different activities, implant positions, pelvic tilt and related aspects on PI.
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Affiliation(s)
- Arnab Palit
- WMG, University of Warwick, Coventry, CV4 7AL, UK.
| | - Richard King
- Department of Trauma & Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yolanda Gu
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - James Pierrepont
- Optimized Ortho, 17 Bridge Street, Pymble, NSW, 2073, Australia
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
| | - David Simpson
- Corin Ltd, Corinium Centre, Cirencester, Gloucestershire, GL7 1YJ, UK
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15
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Calculation of impingement-free combined cup and stem alignments based on the patient-specific pelvic tilt. J Biomech 2019; 82:193-203. [DOI: 10.1016/j.jbiomech.2018.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 11/30/2022]
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16
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Rutherford M, O'Connor JD, Hill JC, Beverland DE, Lennon AB, Dunne NJ. Patient positioning and cup orientation during total hip arthroplasty: assessment of current UK practice. Hip Int 2019; 29:89-95. [PMID: 29783888 DOI: 10.1177/1120700018760818] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: Acetabular cup orientation during total hip arthroplasty (THA) remains a challenge. This is influenced by patient positioning during surgery and the method used to orientate the acetabular cup. The aim of this study was to assess current UK practice for patient positioning and cup orientation, particularly with respect to patient supports and techniques used to achieve target version and inclination. METHODS: A literature review and pilot study were initially conducted to develop the questionnaire, which was completed by British Hip Society members ( n = 183). As the majority of THA surgical procedures within the UK are performed with the patient in lateral decubitus, orthopaedic surgeons who operated with the patient in the supine position were excluded ( n = 18); a further 6% were incomplete and also excluded ( n = 11). RESULTS: Of those who operated in lateral decubitus, 76.6% ( n = 118/154) used the posterior approach. Only 31% ( n = 47/154) considered their supports to be completely rigid. More than 35% ( n = 55/154) were unhappy with the supports that they presently use. The most common methods for controlling operative inclination and version were a mechanical alignment guide (MAG; n = 78/154; 50.6%) and the transverse acetabular ligament (TAL; n = 82/154; 53.2%); 31.2% (48/154) used a freehand technique to control operative inclination. CONCLUSION: Limited studies have been conducted whereby patient supports have been analysed and key design principles outlined. With 35.7% of the orthopaedic surgeons surveyed having issues with their current supports, a greater awareness of essential characteristics for patient supports is required.
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Affiliation(s)
- Megan Rutherford
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - John D O'Connor
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - Janet C Hill
- 2 Primary Joint Unit, Musgrave Park Hospital, Belfast, UK
| | | | - Alex B Lennon
- 1 School of Mechanical and Aerospace Engineering, Queen's University of Belfast, Belfast, UK
| | - Nicholas J Dunne
- 3 Centre for Medical Engineering Research, School of Mechanical and Manufacturing Engineering, Dublin City University, Ireland.,7 School of Mechanical and Manufacturing Engineering, Dublin City University,Ireland
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17
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De Pieri E, Lund ME, Gopalakrishnan A, Rasmussen KP, Lunn DE, Ferguson SJ. Refining muscle geometry and wrapping in the TLEM 2 model for improved hip contact force prediction. PLoS One 2018; 13:e0204109. [PMID: 30222777 PMCID: PMC6141086 DOI: 10.1371/journal.pone.0204109] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 09/04/2018] [Indexed: 11/29/2022] Open
Abstract
Musculoskeletal models represent a powerful tool to gain knowledge on the internal forces acting at the joint level in a non-invasive way. However, these models can present some errors associated with the level of detail in their geometrical representation. For this reason, a thorough validation is necessary to prove the reliability of their predictions. This study documents the development of a generic musculoskeletal model and proposes a working logic and simulation techniques for identifying specific model features in need of refinement; as well as providing a quantitative validation for the prediction of hip contact forces (HCF). The model, implemented in the AnyBody Modeling System and based on the cadaveric dataset TLEM 2.0, was scaled to match the anthropometry of a patient fitted with an instrumented hip implant and to reproduce gait kinematics based on motion capture data. The relative contribution of individual muscle elements to the HCF and joint moments was analyzed to identify critical geometries, which were then compared to muscle magnetic resonance imaging (MRI) scans and, in case of inconsistencies, were modified to better match the volumetric scans. The predicted HCF showed good agreement with the overall trend and timing of the measured HCF from the instrumented prosthesis. The average root mean square error (RMSE), calculated for the total HCF was found to be 0.298*BW. Refining the geometries of the muscles thus identified reduced RMSE on HCF magnitudes by 17% (from 0.359*BW to 0.298*BW) over the whole gait cycle. The detailed study of individual muscle contributions to the HCF succeeded in identifying muscles with incorrect anatomy, which would have been difficult to intuitively identify otherwise. Despite a certain residual over-prediction of the final hip contact forces in the stance phase, a satisfactory level of geometrical accuracy of muscle paths has been achieved with the refinement of this model.
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Affiliation(s)
- Enrico De Pieri
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- * E-mail:
| | | | | | | | - David E. Lunn
- Leeds Teaching Hospitals National Health Service Trust, Leeds, United Kingdom
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18
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Fischer MCM, Eschweiler J, Schick F, Asseln M, Damm P, Radermacher K. Patient-specific musculoskeletal modeling of the hip joint for preoperative planning of total hip arthroplasty: A validation study based on in vivo measurements. PLoS One 2018; 13:e0195376. [PMID: 29649235 PMCID: PMC5896969 DOI: 10.1371/journal.pone.0195376] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 03/21/2018] [Indexed: 11/30/2022] Open
Abstract
Validation of musculoskeletal models for application in preoperative planning is still a challenging task. Ideally, the simulation results of a patient-specific musculoskeletal model are compared to corresponding in vivo measurements. Currently, the only possibility to measure in vivo joint forces is to implant an instrumented prosthesis in patients undergoing a total joint replacement. In this study, a musculoskeletal model of the AnyBody Modeling System was adapted patient-specifically and validated against the in vivo hip joint force measurements of ten subjects performing one-leg stance and level walking. The impact of four model parameters was evaluated; hip joint width, muscle strength, muscle recruitment, and type of muscle model. The smallest difference between simulated and in vivo hip joint force was achieved by using the hip joint width measured in computed tomography images, a muscle strength of 90 N/cm2, a third order polynomial muscle recruitment, and a simple muscle model. This parameter combination reached mean deviations between simulation and in vivo measurement during the peak force phase of 12% ± 14% in magnitude and 11° ± 5° in orientation for one-leg stance and 8% ± 6% in magnitude and 10° ± 5° in orientation for level walking.
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Affiliation(s)
- Maximilian C. M. Fischer
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
- * E-mail:
| | - Jörg Eschweiler
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
- Department for Orthopaedic Surgery, University Hospital RWTH Aachen, Germany
| | - Fabian Schick
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Malte Asseln
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
| | - Philipp Damm
- Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Charité - Universitätsmedizin Berlin, Germany
| | - Klaus Radermacher
- Chair of Medical Engineering, Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Aachen, Germany
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19
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Rivière C, Lazic S, Dagneaux L, Van Der Straeten C, Cobb J, Muirhead-Allwood S. Spine-hip relations in patients with hip osteoarthritis. EFORT Open Rev 2018; 3:39-44. [PMID: 29657844 PMCID: PMC5890167 DOI: 10.1302/2058-5241.3.170020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patients with hip osteoarthritis often have an abnormal spine-hip relation (SHR), meaning the presence of a clinically deleterious spine-hip and/or hip-spine syndrome. Definition of the individual SHR is ideally done using the EOS® imaging system or, if not available, with conventional lumbopelvic lateral radiographs. By pre-operatively screening patients with abnormal SHR, it is possible to refine total hip replacement (THR) surgical planning, which may improve outcomes. An important component of the concept of kinematically aligned total hip arthroplasty (KA THA) consists of defining the optimal acetabular cup design and orientation based on the assessment of an individual’s SHR, and use of the transverse acetabular ligament to adjust the cup positioning. The Bordeaux classification might advance the understanding of SHR and hopefully help improve THR outcomes.
Cite this article: EFORT Open Rev 2018;3:39-44. DOI: 10.1302/2058-5241.3.170020
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Affiliation(s)
- Charles Rivière
- MSK Lab, Imperial College London, UK.,South West London Elective Orthopaedic Centre, UK
| | - Stefan Lazic
- South West London Elective Orthopaedic Centre, UK
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20
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Fernández-Fairen M, Punset M, Murcia-Asensio A, Ferrero-Manzanal F, Sueiro J, Gil J. Microstructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties. J Arthroplasty 2017; 32:3782-3795. [PMID: 28754580 DOI: 10.1016/j.arth.2017.06.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/13/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Besides promising results of metal-on-metal (MOM) hip arthroplasty (HA), frequent failures have been reported even in the short term. Many host, surgical, design, metallurgical, and processing factors have been evoked in the base of these events. We have tried to characterize and to evaluate metallurgical and processing features present in this type of implants. METHODS The acetabular and femoral components of 20 MOM HAs collected from a multicenter retrieval program were examined. All the specimens were inspected with naked eye, with confocal microscopy and vertical scanning interferometry, scanning electron microscopy, back-scattered electron imaging, and energy-dispersive X-ray spectroscopy, in 25 zones of each articular component. RESULTS Gas pores, shrinkage voids and holes of detached carbides, carbides on surface, embedded particles, scratches and marks of wear, surface discoloration, surface deposits, and tribochemical reaction layers were widely dispersed through a substantial percentage of the total bearing surface in all the implanted components. Surface cup and head voids, and cup scratches showed significant correlation with the clearance of pair. A higher surface damage of the cup and head was observed mainly in the low clearance prostheses. There was no other significant correlation or difference in the incidence and importance of any of these defects between resurfacing hip arthroplasties and total hip arthroplasties, or according to the pair diameter. CONCLUSION Some metallurgical features and surface damage were significantly present in the retrieved implants of MoM HAs. It would be desirable to improve the structure and metallurgical characteristics of these implants to avoid those effects and optimize their performance.
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Affiliation(s)
| | - Miquel Punset
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
| | | | | | | | - Javier Gil
- Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain
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21
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Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses. Hip Int 2017; 27:523-531. [PMID: 29027189 DOI: 10.5301/hipint.5000545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. METHODS PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. RESULTS The initial search yielded 1,224 unique articles, and 91 were included in the analysis. CONCLUSIONS There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.
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22
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Amstutz HC, Le Duff MJ, Bhaurla SK. Risk factors for wear-related failures after hip resurfacing in patients with a low contact patch to rim distance. Bone Joint J 2017; 99-B:865-871. [PMID: 28663390 DOI: 10.1302/0301-620x.99b7.bjj-2016-1369.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/22/2017] [Indexed: 11/05/2022]
Abstract
Aims A contact patch to rim (CPR) distance of < 10 mm has been associated with edge-loading and excessive wear. However, not all arthroplasties with a low CPR distance show problems with wear. Therefore, CPR distance may not be the only variable affecting the post-operative metal ion concentrations. Patients and Methods We used multiple logistic regression to determine what variables differed between the patients who had high and low cobalt (CoS) and chromium (CrS) serum ion concentrations within a cohort of patients with low (< 10 mm) CPR distances. A total of 56 patients treated with unilateral hip resurfacing arthroplasty (HRA) had CoS and CrS ion studies performed more than one year after surgery. The mean age of the patients at the time of surgery was 51.7 years (29 to 70), with 38 women (68%) and 18 men (32%). Results It was seen that 47 patients had low ion levels (< 7µg/L) and nine had high ion levels (≥ 7µg/L). We found increased risks of high wear with decreasing CPR distance. Conclusion The use of CPR distance measurements to predict hips at risk for elevated wear is needed for all patients with HRA. We recommend that patients with low CPR distances have at least one serum ion study performed while patients with CPR distance > 10 mm do not need routine ion studies. We believe that patients with low CPR distance and low ions do not need repeat ion studies unless the patient becomes symptomatic or has substantial radiographic changes. Cite this article: Bone Joint J 2017;99-B:865–71.
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Affiliation(s)
- H. C. Amstutz
- St. Vincent Medical Center, 2200
West Third Street, Suite 400, Los
Angeles, California 90057, USA
| | - M. J. Le Duff
- St. Vincent Medical Center, 2200
West Third Street, Suite 400, Los
Angeles, California 90057, USA
| | - S. K. Bhaurla
- St. Vincent Medical Center, 2200
West Third Street, Suite 400, Los
Angeles, California 90057, USA
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23
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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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Contact patch to rim distance: the quintessential tool for metal-on-metal bearing in vivo performance analysis - a review. Hip Int 2017; 27:220-225. [PMID: 28478641 DOI: 10.5301/hipint.5000511] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 02/04/2023]
Abstract
With metal-on-metal (MoM) bearings, fluid film lubrication is disrupted when the contact patch area between the femoral head and the cup is close to the edge of the acetabular component, making the calculation of the contact patch to rim (CPR) distance a key variable in the study of the performance of MoM bearings. A few research centers have used models of varying complexity to calculate the CPR distance and determine its relationship with assessments of component wear. In this review, we aimed to summarise the current knowledge related to the application of CPR distance calculations in the study of in vivo performance of MoM bearings. Our systematic search of the US National Library of Medicine yielded 9 relevant publications in which 3 different models were used for the computation of the CPR distance. The 3 models show different levels of complexity and their use is mainly dependent upon the size of the subject sample and the nature of the data collected as a dependent variable. The studies reviewed consistently showed a strong inverse correlation between CPR distance and wear or metal ion levels suggesting that any study aiming to determine the risk factors for MoM hip devices needs to include an assessment of CPR distance. Cup anteversion can be measured reliably with various tools and should not be an obstacle to the use of this essential variable that is CPR distance.
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Cui P, Jiang W, Fan M, Wan Y. [Detection and influence factor of serum metal ions concentration level after resurfacing arthroplasty of the hip]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:404-409. [PMID: 29798603 PMCID: PMC8498187 DOI: 10.7507/1002-1892.201608018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 02/18/2017] [Indexed: 11/03/2022]
Abstract
Objective To observe the tendency of serum cobalt (Co), chromium (Cr), and molybdenum (Mo) ions concentration level after resurfacing arthroplasty of the hip (RSAH) by inductively coupled plasma mass spectrometer (ICP-MS), and analyze the influence factors. Methods Forty-seven patients (55 hips) underwent RSAH between June 2005 and November 2014 who had good joint function (Harris score were >85) at every review time were selected in the study. There were 25 males and 22 females, with the mean age of 49.7 years (range, 18-64 years). The disease causes included developmental dysplasia of the hip (DDH) in 18 cases (22 hips) and non-DDH in 29 cases (33 hips). The follow-up time was 6 months to 5 years (mean, 3.2 years). The concentrations of Co, Cr, and Mo ions were measured by ICP-MS, and were compared with those of 6 normal controls. Based on the analysis of the measured results, patients were chosen and grouped according to prosthesis position and femoral head prosthesis diameter. A correlative analysis was made between serum metal ions concentration and various factors (age, body mass index, pre- and post-operative Harris scores, neck-shaft angle, and stem-shaft angle). Results The concentration of serum Co ion reached the peak at 1 year after operation ( P<0.05), and then slowly decreased, increased again at 4 years after operation and was close to the 2nd-year level at 5 years. The concentration of serum Cr ion reached its peak at 9 months after operation ( P<0.05), and then gradually decreased, and was close to normal level at 5 years. The concentration of serum Mo ion kept increase trend and reached the peak at 5 years ( P<0.05). Thirty-five hips of 29 patients followed up 9 months and 1 year were grouped. For DDH and non-DDH patients, Co and Cr ion concentrations of 40-45° abduction angle of acetabular component were significantly lower than those of <40° and >45° ( P<0.05), but there was no significant difference in Mo ion concentration ( P>0.05). For all patients, Co, Cr, and Mo ion concentrations of 15-20° anteversion angle of acetabular component were significantly lower than those of <15° and >20° ( P<0.05). Co, Cr, and Mo ion concentrations of ≥48 mm diameter of the femoral component were significantly lower than those of <48 mm ( P<0.05). There was a negative correlation between Co ion and postoperative Harris score ( r=-0.486, P=0.041). Conclusion The serum Co and Cr ions concentrations increase obviously at 1 year and 9 months after RSAH operation, and Mo ion concentration displays an increase trend. The metal ions concentrations have close relationship with the position of acetabular component.
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Affiliation(s)
- Peng Cui
- Department of Orthopaedics, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Wenxue Jiang
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192,
| | - Meng Fan
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192, P.R.China
| | - Yanlin Wan
- Department of Orthopaedics, Tianjin First Center Hospital, Tianjin, 300192, P.R.China
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Clinical and radiographic outcomes of the Birmingham Hip Resurfacing arthroplasty at a minimum follow-up of 10 years: results from an independent centre. Hip Int 2017; 27:134-139. [PMID: 28362050 DOI: 10.5301/hipint.5000424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Metal-on-metal hip resurfacing (MoMHR) has been proposed as an effective surgical treatment for young and active patients with symptomatic hip disease. Recently, good clinical and radiographic outcomes have been reported by the designer surgeons at a 15.3 years follow-up; however, results at long follow-up by non-designer surgeons are less satisfactory. The aim of the study was to investigate if MoMHR can produce satisfactory clinical and radiographic results and if survival rate can be high even if the procedure is performed by non-designer surgeons. METHODS All patients were assessed about implant survival. All patients completed an Oxford Hip Score (OHS), Harris Hip Score (HHS) and a University of California Los Angeles (UCLA) activity score preoperatively, at 1 year and at last available follow-up; at this time, a standard anteroposterior weight-bearing radiograph was performed. RESULTS The survival rate with revision for any reason is 96%, similar to those obtained by designer surgeons. All the clinical scores improved over time: according to the OHS the survivors are asymptomatic and according to the UCLA maintain a high level of function. 6 remodellings of the femoral neck and 2 heterotopic bone formations were seen, but they were asymptomatic. CONCLUSIONS As designer surgeons have already shown, MoMHR can provide in active patients a durable treatment for hip arthritis, with low risk of revision and good results at 10 years follow-up, even if the procedure is performed by non-designer surgeons.
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Oak SR, Strnad GJ, O'Rourke C, Higuera CA, Spindler KP, Brooks PJ. Mid-Term Results and Predictors of Patient-Reported Outcomes of Birmingham Hip Resurfacing. J Arthroplasty 2017; 32:110-118. [PMID: 27480827 DOI: 10.1016/j.arth.2016.06.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/14/2016] [Accepted: 06/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Birmingham hip resurfacing (BHR) is the only Food and Drug Administration approved resurfacing option currently available in the United States. While adequate BHR outcomes are established, there is a paucity of US-based literature demonstrating factors critical to improve patient reported outcomes (PROs). This study answers: (1) What is the implant survivorship in a large US cohort? (2) Which preoperative factors result in higher PRO scores over 5 years postoperatively? METHODS A retrospective 541 hip single-surgeon cohort with mean of 6.2 years follow-up (range 5-8.1) was collected. Preoperative patient/implant variables, including postoperative radiographic acetabular inclination and femoral component position, clinical outcomes, and follow-up PRO questionnaire information were collected. Validated PROs included the Hip Disability and Osteoarthritis Outcome Score (HOOS), Veterans Rand-12, and University of California Los Angeles (UCLA) activity. PROs were modeled with ordinary least squares then used to create nomograms. RESULTS Average patient age was 53 years with 391 (72%) males. Seven hips were revised, resulting in an overall survival of 98.8% at 5 years. Predictive modeling identified preoperative variables (sex, body mass index, smoking, and comorbidity) that had statistically significant associations with HOOS pain (P = .049), HOOS activities of daily living (P = .017), UCLA activity (P < .001), and Veterans Rand-12 physical (P < .001) PROs at latest follow-up. Nomograms predicted follow-up PROs using preoperative patient-specific variables. CONCLUSION This study documents excellent survival of the largest reported single-center cohort of BHRs in the United States with a mean 6.2 years follow-up. Multivariate modeling shows male nonsmokers with low body mass index, and no comorbidities will have less hip pain, better function in daily life, higher activity, and better general physical health after BHR arthroplasty.
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Affiliation(s)
- Sameer R Oak
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Gregory J Strnad
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Colin O'Rourke
- Cleveland Clinic Quantitative Health Sciences, Cleveland, Ohio
| | - Carlos A Higuera
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Kurt P Spindler
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
| | - Peter J Brooks
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio
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Wesseling M, Meyer C, De Groote F, Corten K, Simon JP, Desloovere K, Jonkers I. Gait alterations can reduce the risk of edge loading. J Orthop Res 2016; 34:1069-76. [PMID: 26632197 DOI: 10.1002/jor.23120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 11/28/2015] [Indexed: 02/04/2023]
Abstract
Following metal-on-metal hip arthroplasty, edge loading (i.e., loading near the edge of a prosthesis cup) can increase wear and lead to early revision. The position and coverage angle of the prosthesis cup influence the risk of edge loading. This study investigates the effect of altered gait patterns, more specific hip, and pelvis kinematics, on the orientation of hip contact force and the consequent risk of antero-superior edge loading using muscle driven simulations of gait. With a cup orientation of 25° anteversion and 50° inclination and a coverage angle of 168°, many gait patterns presented risk of edge loading. Specifically at terminal double support, 189 out of 405 gait patterns indicated a risk of edge loading. At this time instant, the high hip contact forces and the proximity of the hip contact force to the edge of the cup indicated the likelihood of the occurrence of edge loading. Although the cup position contributed most to edge loading, altering kinematics considerably influenced the risk of edge loading. Increased hip abduction, resulting in decreasing hip contact force magnitude, and decreased hip extension, resulting in decreased risk on edge loading, are gait strategies that could prevent edge loading. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1069-1076, 2016.
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Affiliation(s)
- Mariska Wesseling
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
| | - Christophe Meyer
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Friedl De Groote
- Division PMA, Department of Mechanical Engineering, KU Leuven, Heverlee, Belgium
| | - Kristoff Corten
- Department of Orthopaedic, Ziekenhuis Oost-Limburg, Hip Unit, Genk, Belgium
| | - Jean-Pierre Simon
- Department of UZ Pellenberg Orthopedic, University Hospitals Leuven, Pellenberg, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ilse Jonkers
- Department of Kinesiology, Human Movement Biomechanics, KU Leuven, Heverlee, Belgium
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Akrawi H, Hossain FS, Niculescu S, Hashim Z, Ng AB, Shetty A. Midterm results of 36 mm metal-on-metal total hip arthroplasty. Indian J Orthop 2016; 50:256-62. [PMID: 27293285 PMCID: PMC4885293 DOI: 10.4103/0019-5413.181786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Despite the many perceived benefits of metal-on-metal (MoM) articulation in total hip arthroplasty (THA), there have been growing concerns about metallosis and adverse reaction to metal debris (ARMD). Analysis of size 36 mm MoM articulation THAs is presented. These patients were evaluated for patient characteristics, relationship between blood metal ions levels and the inclination as well as the version of acetabular component, cumulative survival probability at final followup and functional outcome at final followup. MATERIALS AND METHODS 288, size 36 mm MoM THAs implanted in 269 patients at our institution from 2004 to 2010 were included in this retrospective study. These patients were assessed clinically for hip symptoms, perioperative complications and causes of revision arthroplasty were analysed. Biochemically, blood cobalt and chromium metal ions level were recorded and measurements of acetabular inclination and version were examined. Radiological evaluation utilizing Metal Artefact Reduction Sequence (MARS) MRI was undertaken and implant cumulative survivorship was evaluated. RESULTS The mean followup was 5 years (range 2-7 years), mean age was 73 years and the mean Oxford hip score was 36.9 (range 5-48). Revision arthroplasty was executed in 20 (7.4%) patients, of which 15 patients underwent single-stage revision THA. The causes of revision arthroplasty were: ARMD changes in 6 (2.2%) patients, infection in 5 (1.9%) patients and aseptic loosening in 5 (1.9%) patients. Three (1.1%) patients had their hips revised for instability, 1 (0.3%) for raised blood metal ions levels. The implant cumulative survival rate, with revision for any reason, was 68.9% at 7 years. CONCLUSIONS Although medium-sized MoM THA with a 36 mm head has a marginally better survivorship at midterm followup, compared to larger size head MoM articulating THA, our findings nonetheless are still worryingly poor in comparison to what has been quoted in the literature. Furthermore, ARMD-related revision remains the predominant cause of failure in this cohort with medium-sized MoM articulation. No correlation was found between blood metal ions levels and the inclination as well as the version of acetabular component.
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Affiliation(s)
- Hawar Akrawi
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK,Address for correspondence: Mr. Hawar Akrawi, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK. E-mail:
| | - Fahad S Hossain
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - Stefan Niculescu
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - Zaid Hashim
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - Arron Biing Ng
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - Ajit Shetty
- Department of Trauma and Orthopaedics, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
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Abstract
Hip resurfacing has been proposed as an alternative to traditional total hip arthroplasty in young, active patients. Much has been learned following the introduction of metal-on-metal resurfacing devices in the 1990s. The triad of a well-designed device, implanted accurately, in the correct patient has never been more critical than with these implants. Following Food and Drug Administration approval in 2006, we studied the safety and effectiveness of one hip resurfacing device (Birmingham Hip Resurfacing) at our hospital in a large, single-surgeon series. We report our early to mid–term results in 1333 cases followed for a mean of 4.3 years (2 to 5.7) using a prospective, observational registry. The mean patient age was 53.1 years (12 to 84); 70% were male and 91% had osteoarthritis. Complications were few, including no dislocations, no femoral component loosening, two femoral neck fractures (0.15%), one socket loosening (0.08%), three deep infections (0.23%), and three cases of metallosis (0.23%). There were no destructive pseudotumours. Overall survivorship at up to 5.7 years was 99.2%. Aseptic survivorship in males under the age of 50 was 100%. We believe this is the largest United States series of a single surgeon using a single resurfacing system. Cite this article: Bone Joint J 2016;98-B (1 Suppl A):10–13.
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Affiliation(s)
- P. J. Brooks
- Cleveland Clinic, 9500
Euclid Ave, A-41, Cleveland, Ohio, 44195, USA
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Lons A, Arnould A, Pommepuy T, Drumez E, Girard J. Excellent short-term results of hip resurfacing in a selected population of young patients. Orthop Traumatol Surg Res 2015; 101:661-5. [PMID: 26362039 DOI: 10.1016/j.otsr.2015.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 07/01/2015] [Accepted: 07/17/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip resurfacing (HR) is an alternative option to total hip arthroplasty (THA) in a population of selected patients (young and/or active). HYPOTHESIS The short-term survivorship rate is as least as good as that for THA with no abnormal increase in serum metal ion levels. MATERIALS AND METHODS A continuous prospective series of 502 hip resurfacings in 481 patients mean age 48.7 years old (±10.3; 18-68) (Conserve Plus, Wright Medical Technology) was analyzed clinically, radiologically and biologically (total blood chrome, cobalt and titanium metal ion levels). Mean follow up was 4.1 years (1.9-4.9). RESULTS There were no dislocations. There were 5 cases of revision surgery with component replacement (including 2 infections). Implant survivorship using implant removal as the criteria (excluding infection) was 99.4% at 4 years (CI 95%: 98.1-99.8). The evaluation of metal ion levels showed a significant increase in cobalt from a preoperative level of 0.24 μg/L (0.01-3.6) to 0.86 μg/L (0.01-5.7) at the final follow-up (P<0.001). Chrome and titanium levels went from 0.68 μg/L (0.01-4.4) and 2.36 μg/L (0.39-7) to 1.28 μg/L (0.1-5.5) and 4.49 μg/L (1.29-8.21) respectively (P<0.001). All clinical scores had significantly improved at the final follow-up. Mean frontal plane cup inclination was 42.7° (35-62). DISCUSSION In a selected population of young and/or active patients, the short-term results of hip resurfacing are excellent. At the postoperative 4-year follow-up the rate of complications (in particular the absence of dislocations) was less than that for THA in young and/or active patients. Certain conditions must be respected to obtain these results; frontal plane cup inclination of between 40 and 45°, a femoral head diameter of at least 48 mm and good quality femoral bone. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- A Lons
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - A Arnould
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie D, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - T Pommepuy
- Université Lille Nord de France, 59000 Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France
| | - E Drumez
- Université Lille Nord de France, 59000 Lille, France; Unité biostatistiques pôle santé publique, maison régionale de la recherche clinique, CERIM, 154, rue du Docteur-Yersin, 59000 Lille, France
| | - J Girard
- Université Lille Nord de France, 59000 Lille, France; Département de médecine du sport, faculté de médecine de Lille, université de Lille 2, Lille, France; Service d'orthopédie C, hôpital Salengro, place de Verdun, CHU de Lille, 59000 Lille, France.
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