Do We Medialise the Hip Centre of Rotation in Total Hip Arthroplasty? Influence of Acetabular Offset and Surgical Technique

Bonnin, Michel; Archbold, P.; Basiglini, Luca; Fessy, Michel-Henry; Beverland, David

doi:10.5301/hip.2012.9350

Cited by 85 publications

(66 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The joint loading may be subject to a step change in contact force resulting from medialization of the joint center, and transient changes associated with favoring the nonoperated leg and the use of a cane or walking frame. Therefore, a load scaling factor "^Load" was applied to account for the pre-to postoperative medialization of the joint center (load ratio 0.92) [36,37], and for walking with a cane (load ratio 0.60-0.78) [38,39] for a 1.5 month rehabilitation period (frehab)-These scale factors were used to create suggested activity and load profiles over the simulation time (Fig. 3) which demonstrate respectively the changes in the number of gait cycles per day, and in the magnitude of joint contact and abductor muscle force, over the years following surgery.…”

Section: Methodsmentioning

confidence: 99%

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

Dickinson

2014

Journal of Biomechanical Engineering

View full text Add to dashboard Cite

Periprosthetic bone remodeling is frequently observed after total hip replacement. Reduced bone density increases the implant and bone fracture risk, and a gross loss of bone density challenges fixation in subsequent revision surgery. Computational approaches allow bone remodeling to be predicted in agreement with the general clinical observations of proximal resorption and distal hypertrophy. However, these models do not reproduce other clinically observed bone density trends, including faster stabilizing mid-stem density losses, and loss-recovery trends around the distal stem. These may resemble trends in postoperative joint loading and activity, during recovery and rehabilitation, but the established remodeling prediction approach is often used with identical pre- and postoperative load and activity assumptions. Therefore, this study aimed to evaluate the influence of pre- to postoperative changes in activity and loading upon the predicted progression of remodeling. A strain-adaptive finite element model of a femur implanted with a cemented Charnley stem was generated, to predict 60 months of periprosthetic remodeling. A control set of model input data assumed identical pre- and postoperative loading and activity, and was compared to the results obtained from another set of inputs with three varying activity and load profiles. These represented activity changes during rehabilitation for weak, intermediate and strong recoveries, and pre- to postoperative joint force changes due to hip center translation and the use of walking aids. Predicted temporal bone density change trends were analyzed, and absolute bone density changes and the time to homeostasis were inspected, alongside virtual X-rays. The predicted periprosthetic bone density changes obtained using modified loading inputs demonstrated closer agreement with clinical measurements than the control. The modified inputs also predicted the clinically observed temporal density change trends, but still under-estimated density loss during the first three postoperative months. This suggests that other mechanobiological factors have an influence, including the repair of surgical micro-fractures, thermal damage and vascular interruption. This study demonstrates the importance of accounting for pre- to postoperative changes in joint loading and patient activity when predicting periprosthetic bone remodeling. The study's main weakness is the use of an individual patient model; computational expense is a limitation of all previously reported iterative remodeling analysis studies. However, this model showed sufficient computational efficiency for application in probabilistic analysis, and is an easily implemented modification of a well-established technique.

show abstract

Section: Methodsmentioning

confidence: 99%

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

Dickinson

2014

Journal of Biomechanical Engineering

View full text Add to dashboard Cite

show abstract

“…Excessive medialization may lead to impingement, especially when peripheral osteophytes are not removed, due to premature contact between proximal femur and pelvic bone/soft tissue (BBI) 789. Conversely, excessively lateral placement of cup, especially in a horizontal position with lateral uncoverage, can also lead to impingement between metal femoral neck and cup liner (CCI) leading to early loosening 24.…”

Section: Section I – Defining Cup Positionmentioning

confidence: 99%

“…The consequences of malposition include instability,2 increased wear,345 impaired muscle function,6 reduced range of motion (ROM),7 impingement,789 bearing-related noise generation,1011 poor functional outcomes,12 limb length discrepancy,1314 and loosening and cup failure 151617. Despite advances in technique, accuracy of cup placement remains variable.…”

Section: Introductionmentioning

confidence: 99%

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

Bhaskar

Rajpura

Board

2017

IJOO

View full text Add to dashboard Cite

Being one of the most successful surgeries in the history of medicine, the indications for total hip arthroplasty have widened and are increasingly being offered to younger and fitter patients. This has also led to high expectations for longevity and outcomes. Acetabular cup position has a significant impact on the results of hip arthroplasty as it affects dislocation, abductor muscle strength, gait, limb lengths, impingement, noise generation, range of motion (ROM), wear, loosening, and cup failure. The variables in cup position are depth, height, and angular position (anteversion and inclination). The implications of change in depth of center of rotation (COR) are medialized versus anatomical positioning. As opposed to traditional medialization with beneficial effects on joint reaction force, the advantages of an anatomical position are increasingly recognized. The maintained acetabular offset offers advantages in terms of ROM, impingement, cortical rim press fit, and maintaining medial bone stock. The height of COR influences muscle activity and limb lengths and available bone stock for cup support. On the other hand, ideal angular position remains a matter of much debate and reliably achieving a target angular position remains elusive. This is not helped by variations in the way we describe angular position, with operative, radiologic, or anatomic definitions being used variably to describe anteversion and inclination. Furthermore, pelvic tilt plays a major role in functional positions of the acetabulum. In addition, commonly used techniques of positioning often do not inform us of the real orientation of the pelvis on operating table, with possibility of significant adduction, flexion, and external rotation of the pelvis being possibilities. This review article brings together the evidence on cup positioning and aims to provide a systematic and pragmatic approach in achieving the best position in individual cases.

show abstract

“…41-43 A reduction of the offset can lead to a decrease in both the lever arm and in abductor strength. This can in turn lead to a THA impingement, to bone-to-bone impingement and even to the patient limping.…”

Section: Acetabular and Femoral Offsetmentioning

confidence: 99%

What do we get from navigation in primary THA?

et al. 2016

View full text Add to dashboard Cite

Navigation in primary total hip arthroplasty has a history of over 20 years. During this process, imageless computer navigation can be particularly helpful in optimally restoring the hip’s biomechanics. This involves the accurate placement of the acetabular component with the determination of the anteversion and abduction, whereby the navigated femur-first technique also allows for a calculation of the combined anteversion. Additional critical parameters such as the reconstruction of the rotation centre, as well as the femoral and acetabular offset, can also be optimally adjusted. Last but not least, an intra-operative evaluation and equalisation of the leg length is possible.Nonetheless, the disadvantages of this surgical technique in terms of the high costs in the acquisition and preservation of the necessary devices, as well as the longer operation time, must be taken into account. However, economic aspects are not the only thing preventing widespread use of the navigation technique. Determining the plane of reference (APP) for the optimal orientation of the implants is based on palpation of the bony landmarks – and this is influenced by the thickness of the soft tissue layer. Furthermore, the experience of the surgeon constitutes a variable that influences the accuracy of navigation.In summary, hip navigation certainly offers an interesting technique for the optimisation of total hip arthroplasty with reconstruction of proper biomechanics. At the same time, there is currently a lack of high-quality randomised controlled long-term trials that evaluate the clinical advantage for the patients, together with cost utility and survival rates.Cite this article: Renner L, Janz V, Perka C, Wassilew GI. What do we get from navigation in primary THA? EFORT Open Rev 2016;1:205-210. 10.1302/2058-5241.1.000034.

show abstract

Do We Medialise the Hip Centre of Rotation in Total Hip Arthroplasty? Influence of Acetabular Offset and Surgical Technique

Cited by 85 publications

References 34 publications

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

Activity and Loading Influence the Predicted Bone Remodeling Around Cemented Hip Replacements

Current Concepts in Acetabular Positioning in Total Hip Arthroplasty

What do we get from navigation in primary THA?

Contact Info

Product

Resources

About