Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty

Weber, Markus; Woerner, Michael; Craiovan, Benjamin; Voellner, Florian; Worlicek, Michael; Springorum, Hans-Robert; Grifka, Joachim; Renkawitz, Tobias

doi:10.1007/s00264-016-3171-x

Cited by 32 publications

(32 citation statements)

References 30 publications

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“…Besides, here a synthetic femur was analysed, other authors considered cadaveric bones; in some cases, 9 the only prosthetic components were modeled; lastly, the stem anteversion angle is usually larger than 0°; however, according to literature 'combined anteversion' that is the sum of femoral and acetabular anteversion is the key parameter, at least with reference to prosthetic impingement. 25 According to this, results here obtained for a given '' anteversion, can be compared to those reported for 20° femoral anteversion and (-20) acetabular anteversion.…”

Section: Discussionmentioning

confidence: 67%

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Zanetti¹,

Bignardi²,

Terzini³

et al. 2018

AMJ

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BackgroundThe dislocation of the prosthesized hip is a relevant postoperative complication; this adverse outcome is dependent on the specific patient anatomy and on the artificial joint design. The geometry of the reconstructed hip is one of the key factors and it is usually designed at the time of the preoperative planning when the stem model and size, the head diameter and its offset, and the acetabular cup orientation are selected. AimsIn this work, the authors have developed a numerical model to support the pre-operative planning, allowing assessing the hip range of motion, once the geometry of the implant has been defined. MethodsA multi-body model of a prosthesized hip has been developed, and a dislocating movement has been applied; the software is able to assess the entity of displacements and of applied forces which can produce hip dislocation. ResultsAs a proof of concept, multiple combinations of geometric factors have been examined that are the head diameter, the acetabular cup anteversion and its inclination, reaching a total number of 675 configurations. This software is able to analyse and compare all configurations in few minutes. ConclusionThe developed numerical model can be a support to quickly compare a great number of solutions from the point of view of hip stability, reaching a comprehensive view of all possibilities, and giving a contribute to the final aim that is surgery optimization, in relation to each specific patient. What this study adds: What is known about this subject?Hip dislocation is a relevant complication in hip arthroplasty; this adverse outcome is dependent on the specific patient anatomy and on the artificial joint design. What new information is offered in this study?This study introduced a methodology, based on multibody model, which allows optimising the choice of prosthetic components and their positioning in relation to dislocation risk. What are the implications for research, policy, or practice?The pre-operative planning of hip arthroplasty can take benefit from numerical methods able to foresee the final hip range of motion.

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Section: Discussionmentioning

confidence: 67%

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Zanetti¹,

Bignardi²,

Terzini³

et al. 2018

AMJ

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“…31,33 It occurs due to unintended contact between femoral bones (e.g., greater trochanter, lesser trochanter, femoral neck) and acetabular margin (which is called ''limbus acetabuli''), ilium or ischium (the anterior superior iliac spines is part of the ilium). 11,32,35 ITBI could be partially controlled by changing implant designs and their positions and orientations. Therefore, it is usually recommended to recreate genuine bone morphology by resecting osteophytes completely during THA to avoid post-THA BTBI and ITBI.…”

Section: Introductionmentioning

confidence: 99%

Bone-to-Bone and Implant-to-Bone Impingement: A Novel Graphical Representation for Hip Replacement Planning

et al. 2020

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Bone-to-bone impingement (BTBI) and implantto-bone impingement (ITBI) risk assessment is generally performed intra-operatively by surgeons, which is entirely subjective and qualitative, and therefore, lead to sub-optimal results and recurrent dislocation in some cases. Therefore, a method was developed for identifying subject-specific BTBI and ITBI, and subsequently, visualising the impingement area on native bone anatomy to highlight where prominent bone should be resected. Activity definitions and subjectspecific bone geometries, with planned implants were used as inputs for the method. The ITBI and BTBI boundary and area were automatically identified using ray intersection and region growing algorithm respectively to retain the same 'conical clearance angle' obtained to avoid prosthetic impingement (PI). The ITBI and BTBI area was then presented with different colours to highlight the risk of impingement, and importance of resection. A clinical study with five patients after 2 years of THA was performed to validate the method. The results supported the study hypothesis, in that the predicted highest risk area (red coloured zone) was completely/majorly resected during the surgery. Therefore, this method could potentially be used to examine the effect of different pre-operative plans and hip motions on BTBI, ITBI, and PI, and to guide bony resection during THA surgery.

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“…A number of target ranges regarding combined anteversion are described in the literature [34, 38 -41]. These target ranges are suitable for detecting periprosthetic impingement but cannot detect and thus prevent bony impingement [42].…”

Section: Positioning the Acetabular Cup During Total Hip Arthroplastymentioning

confidence: 99%

Patient-Specific Restoration of Biomechanics in Total Hip Arthroplasty

2018

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ZusammenfassungEine exakte Rekonstruktion der Biomechanik ist ein wesentlicher Bestandteil in der Hüftendoprothetik für eine gute postoperative Beweglichkeit und Stabilität des Kunstgelenks. Die präoperative Planung des Beinlängen- und Offsetausgleichs wird üblicherweise auf größenskalierten konventionellen Röntgenbildern durchgeführt, die jedoch durch die zweidimensionale Projektion der Gefahr von Fehlberechnungen unterliegen. Insbesondere das femorale Offset wird dabei häufig unterschätzt. Bei der Rekonstruktionsgenauigkeit von Beinlänge und Offset sollten Unterschiede von über 1 cm postoperativ vermieden werden. Analysen der Gangkinematik zeigen jedoch bereits Veränderungen im Gangmuster bei Beinlängen- und Offsetunterschieden von über 5 mm. Neben einer Vielzahl anderer Methoden eignen sich zur intraoperativen Umsetzung der Beinlängen- und Offsetrekonstruktion sowohl die bildfreie Navigation als auch die Fluoroskopie. Eine Abschätzung der Schafttorsion der einliegenden Endoprothese ist neben des Goldstandards CT auch auf konventionellen Röntgenaufnahmen mithilfe der Bestimmung des projizierten CCD-Winkels möglich. Als prädiktiver Parameter eignet sich die Isthmus-Ratio (iRatio), um bereits präoperativ nativradiologisch einen Hinweis der intraoperativ zu erwartenden Schafttorsion zu erhalten. Die Größe des Trochanter minor hilft, eine Abschätzung der nativen Torsion des Femurs treffen zu können.

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Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty

Abstract: Standard rules of combined anteversion detect prosthetic but fail to prevent combined osseous and prosthetic impingement in THA. Future models will have to account for the patient-individual anatomic situation to ensure impingement-free ROM.

Cited by 32 publications

References 30 publications

A multibody model for the optimization of hip arthroplasty in relation to range of movement

A multibody model for the optimization of hip arthroplasty in relation to range of movement

Bone-to-Bone and Implant-to-Bone Impingement: A Novel Graphical Representation for Hip Replacement Planning

Patient-Specific Restoration of Biomechanics in Total Hip Arthroplasty

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