Acetabular Anteversion with CT in Supine, Simulated Standing, and Sitting Positions in a THA Patient Population

Lazennec, Jean-Yves; Boyer, Patrick; Gorin, Michel; Catonné, Yves; Rousseau, M.-A.

doi:10.1007/s11999-010-1732-7

Cited by 136 publications

(122 citation statements)

References 33 publications

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“…With only one male in this set of 10 retrievals, it could not be determined if there were sex-specific differences arising from variation in pelvic shape. This aspect is being investigated in an ongoing EOS-imaging project [40]. Our study is also specific to the femoral stem and cup designs used in these 28-mm MoM THAs.…”

Section: Discussionmentioning

confidence: 99%

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Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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Background Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, ''steep cups,'' ''microseparation,'' and ''edge wear.'' Questions/purposes We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of thirdbody scratches on bearings that would indicate large abrasive particles had circulated the joint space. Methods Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns.

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Section: Discussionmentioning

confidence: 99%

“…All patients were imaged by conventional radiography and by a slot scanning, x-ray system (EOS1; Biospace, Paris, France) [17,39,[41][42][43]70]. Implant orientations and contact patch to rim distance (CPR) [36] data were incorporated in each image.…”

Section: Standard Radiography and Eosmentioning

confidence: 99%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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“…However, more recently a topic of considerable discussion is dynamic sagittal pelvic tilt and its role in deciding the optimal position of the acetabular component to avoid instability [21,30]. Variability in pelvic tilt can change acetabular component orientation after THA, and hip replacement surgeons have investigated pelvic tilt in sitting posture [11,19,20], because posterior dislocations often occur when a patient is rising from a chair. Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement.…”

Section: Introductionmentioning

confidence: 99%

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Esposito

Miller

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

194

177

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Background Sitting pelvic tilt dictates the proximity of the rim of the acetabulum to the proximal femur and, therefore, the risk of impingement in patients undergoing total hip arthroplasty (THA). Sitting position is achieved through a combination of lumbar spine segmental motions and/or femoroacetabular articular motion in the lumbarpelvic-femoral complex. Multilevel degenerative disc disease (DDD) may limit spine flexion and therefore increase femoroacetabular flexion in patients having THAs, but this has not been well characterized. Therefore, we measured standing and sitting lumbar-pelvic-femoral alignment in patients with radiographic signs of DDD and in patients with no radiographic signs of spine arthrosis.Questions/purposes We asked: (1) Is there a difference in standing and sitting lumbar-pelvic-femoral alignment before surgery among patients undergoing THA who have no radiographic signs of spine arthrosis compared with those with preexisting lumbar DDD? (2) Do patients with lumbar DDD experience less spine flexion moving from a standing to a sitting position and therefore compensate with more femoroacetabular flexion compared with patients who have no radiographic signs of arthrosis? Methods Three hundred twenty-five patients undergoing primary THA had preoperative low-dose EOS spine-toankle lateral radiographs in standing and sitting positions. Eighty-three patients were excluded from this study for scoliosis (39 patients), spondylolysis (15 patients), not having five lumbar vertebrae (7 patients), surgical or disease fusion (11 patients), or poor image quality attributable to high BMI (11 patients). In the remaining 242 of 325 patients (75%), two observers categorized the lumbar spine as either without radiographic arthrosis or having DDD based on defined radiographic criteria. Sacral slope, lumbar lordosis, and proximal femur angles were measured, and these angles were used to calculate lumbar spine flexion and femoroacetabular flexion in standing and sitting positions. Patients were aligned in a standardized sitting position so that their femurs were parallel to the floor to achieve approximately 90°of apparent hip flexion. Results After controlling for age, sex, and BMI, we found patients with DDD spines had a mean of 5°more posterior pelvic tilt (95% CI, À2°to À8°lower sacral slope angles; p \0.01) and 7°less lumbar lordosis (95% CI, À10°to À3°; p \ 0.01) in the standing position compared with patients without radiographic arthrosis. However, in the sitting position, patients with DDD spines had 4°less posterior pelvic tilt (95% CI, 1°-7°higher sacral slope angles; p = 0.02). From standing to sitting position, patients with DDD

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“…All occur during functional activities when the position of the pelvis and femur are different from that seen on standard radiographs or on the operating table [6][7][8][9][10][11]. Hip kinematics are specific to each individual and change the functional alignment of the components [10].…”

Section: Introductionmentioning

confidence: 99%

Patient Specific Component Alignment in Total Hip Arthroplasty

Pierrepont

Stambouzou²,

Miles³

et al. 2016

ReconRev

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Appropriate component alignment is critical for improving stability, maximising bearing performance and restoring native anatomy after Total Hip Arthroplasty (THA). Due to the large variation in patient kinematics between functional activities, current technologies lack definition of what constitutes correct target alignment. Analysis of a large series of symptomatic THA patients confirms that apparently wellorientated components on standard radiographs can still fail due to functional component malalignment. Evidently, previously defined "safe zones" are not appropriate for all patients as they do not consider the dynamic behaviour of the hip joint.The Optimized Positioning System™ (OPS™) comprises preoperative planning based on a patientspecific dynamic analysis, and patient-specific instrumentation for delivery of the target component alignment. This paper presents the application of OPS™ in three case studies.

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Acetabular Anteversion with CT in Supine, Simulated Standing, and Sitting Positions in a THA Patient Population

Cited by 136 publications

References 33 publications

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Does Degenerative Lumbar Spine Disease Influence Femoroacetabular Flexion in Patients Undergoing Total Hip Arthroplasty?

Patient Specific Component Alignment in Total Hip Arthroplasty

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