Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty  – An Experimental Study

Qurashi, Suleman; Parr, William C.; Jang, Bob; Walsh, William R.

doi:10.15438/rr.7.4.195

Cited by 6 publications

(6 citation statements)

References 34 publications

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“…Additionally, impingement limits the ROM and is a common cause of postoperative instability [47,65]. ROM analyses have raised much attention from the research community using experimental [24][25][26][27][28][29] and numerical methods [21,30,43,44,[46][47][48][49][50]. However, to the best of our knowledge, there is no approach published to assess ROM after THR in surgery planning without applying additional radiation to the patient; for example, by CT scanning.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, the occurrence of impingement is manually assessed by an orthopedic surgeon, by intraoperatively imposing specific motion patterns while the impingement is detected [23]. To analyze the maximum ROM of different implant designs, several experimental [24][25][26][27][28][29] and computational studies [13,18,20,21,23,[30][31][32][33][34][35][36][37][38], using computer-aided design (CAD), finite element analyses, or multibody simulations, have been conducted. Previous studies described the effect of the orientation of the acetabular cup, prosthetic head size on the impingement, and risk of dislocation [21,39,40].…”

Section: Introductionmentioning

confidence: 99%

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An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

et al. 2021

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The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact® hip stem and Plasmacup® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆ROM) of maximum flexion (∆ROM = 0°, p = 0.854) and internal rotation (∆ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

et al. 2021

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“…Lateral approach THAs do not seem to benefit from lipped PE liners. Further studies are needed to examine the effects of lip position on revision for instability, with some biomechanical 25 and intraoperative 26 studies suggesting the posteroinferior quadrant to confer better stability. Additionally, studies are needed to determine if a true difference exists between 10° and 15° liners, and whether the benefits of lipped liners persist into longer-term follow-up.…”

Section: Discussionmentioning

confidence: 99%

The effect of uncemented acetabular liner geometry and lip size on the risk of revision for instability or loosening

Divecha

O’Neill

Board

2021

The Bone & Joint Journal

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Aims The aim of this study was to determine if uncemented acetabular polyethylene (PE) liner geometry, and lip size, influenced the risk of revision for instability or loosening. Methods A total of 202,511 primary total hip arthroplasties (THAs) with uncemented acetabular components were identified from the National Joint Registry (NJR) dataset between 2003 and 2017. The effect of liner geometry on the risk of revision for instability or loosening was investigated using competing risk regression analyses adjusting for age, sex, American Society of Anesthesiologists grade, indication, side, institution type, surgeon grade, surgical approach, head size, and polyethylene crosslinking. Stratified analyses by surgical approach were performed, including pairwise comparisons of liner geometries. Results The distribution of liner geometries were neutral (39.4%; 79,822), 10° (34.5%; 69,894), 15° (21.6%; 43,722), offset reorientating (2.8%; 5705), offset neutral (0.9%; 1,767), and 20° (0.8%; 1,601). There were 690 (0.34%) revisions for instability. Compared to neutral liners, the adjusted subhazard ratios of revision for instability were: 10°, 0.64 (p < 0.001); 15°, 0.48 (p < 0.001); and offset reorientating, 1.6 (p = 0.010). No association was found with other geometries. 10° and 15° liners had a time-dependent lower risk of revision for instability within the first 1.2 years. In posterior approaches, 10° and 15° liners had a lower risk of revision for instability, with no significant difference between them. The protective effect of lipped over neutral liners was not observed in laterally approached THAs. There were 604 (0.3%) revisions for loosening, but no association between liner geometry and revision for loosening was found. Conclusion This registry-based study confirms a lower risk of revision for instability in posterior approach THAs with 10° or 15° lipped liners compared to neutral liners, but no significant difference between these lip sizes. A higher revision risk is seen with offset reorientating liners. The benefit of lipped geometries against revision for instability was not seen in laterally approached THAs. Liner geometry does not seem to influence the risk of revision for loosening. Cite this article: Bone Joint J 2021;103-B(12):1774–1782.

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“… 29 The effect of the position of the asymmetric part of the liner (lip) can have a marked effect on the range of motion prior to dislocation as revealed in in vivo and ex vivo studies. 12 , 27 , 30 The association between increased impingement in elevated rim liners and reduced prosthetic joint survival has not been proven. Cobb et al 17 analyzed their institutional database and reported no increase in the risk of revision due to loosening of the acetabular or femoral components when elevated rim liners were used.…”

Section: Discussionmentioning

confidence: 99%

Using an asymmetric crosslinked polyethylene liner in primary total hip arthroplasty is associated with a lower risk of revision surgery

Davis

Pagkalos

Kopjar

2021

The Bone & Joint Journal

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Aims The aim of our study was to investigate the effect of asymmetric crosslinked polyethylene liner use on the risk of revision of cementless and hybrid total hip arthroplasties (THAs). Methods We undertook a registry study combining the National Joint Registry dataset with polyethylene manufacturing characteristics as supplied by the manufacturers. The primary endpoint was revision for any reason. We performed further analyses on other reasons including instability, aseptic loosening, wear, and liner dissociation. The primary analytic approach was Cox proportional hazard regression. Results A total of 213,146 THAs were included in the analysis. Overall, 2,997 revisions were recorded, 1,569 in THAs with a flat liner and 1,428 in THAs using an asymmetric liner. Flat liner THAs had a higher risk of revision for any reason than asymmetric liner THAs when implanted through a Hardinge/anterolateral approach (hazard ratio (HR) 1.169, 95% confidence interval (CI) 1.022 to 1.337) and through a posterior approach (HR 1.122, 95% CI 1.108 to 1.346). There was no increased risk of revision for aseptic loosening when asymmetric liners were used for any surgical approach. A separate analysis of the three most frequently used crosslinked polyethylene liners was in agreement with this finding. When analyzing THAs with flat liners only, THAs implanted through a Hardinge/anterolateral approach were associated with a reduced risk of revision for instability compared to posterior approach THAs (HR 0.561 (95% CI 0.446 to 0.706)). When analyzing THAs with an asymmetric liner, there was no significant difference in the risk of revision for instability between the two approaches (HR 0.838 (95% CI 0.633 to 1.110)). Conclusion For THAs implanted through the posterior approach, the use of asymmetric liners reduces the risk of revision for instability and revision for any reason. In THAs implanted through a Hardinge/anterolateral approach, the use of an asymmetric liner was associated with a reduced risk of revision. The effect on revision for instability was less pronounced than in the posterior approach. Cite this article: Bone Joint J 2021;103-B(9):1479–1487.

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Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study

Cited by 6 publications

References 34 publications

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

The effect of uncemented acetabular liner geometry and lip size on the risk of revision for instability or loosening

Using an asymmetric crosslinked polyethylene liner in primary total hip arthroplasty is associated with a lower risk of revision surgery

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