Impingement with Total Hip Replacement

Malik, Aamer; Maheshwari, Aditya V.; Dorr, Lawrence D.

doi:10.2106/jbjs.f.01313

Cited by 304 publications

(277 citation statements)

References 62 publications

Supporting

Mentioning

267

Contrasting

Unclassified

Order By: Relevance

“…The etiology of hip instability is multifactorial and often has been associated with such surgical variables as operative approach, implant choice and position, and soft tissue repair [6,34]. 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.…”

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

197

177

View full text Add to dashboard Cite

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

show abstract

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

197

177

View full text Add to dashboard Cite

show abstract

“…1), surgical positioning, and effects of ''edge loading'' [12,23,29,38,58,59,76]. Additionally, impingement, subluxation, and dislocation have always been unpredictable risk considerations [3,18,22,24,27,28,31,43,52,66,72,74,77,80]. Aggressive third-body abrasive wear can be one result of THA impingement [10,24,26,27,50].…”

Section: Introductionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…The position of the hip center is crucial for optimal functioning of the hip musculature [2,[10][11][12], for reducing joint contact forces [18], and for avoiding accelerated wear, impingement, and loosening [9,22,28]. Its accurate determination is a major variable over which the surgeon has some control in reconstructive surgery around the hip.…”

Section: Discussionmentioning

confidence: 99%

“…Anteroposterior (AP) displacement, which is invisible on AP radiographs, alters the moment-generating capacity of the flexors and extensors considerably [10]. Optimal placement of the acetabulum is also crucial to avoid impingement, accelerated wear, and loosening in a reconstructed hip [9,22,28].…”

Section: Introductionmentioning

confidence: 99%

Can the Acetabular Position be Derived from a Pelvic Frame of Reference?

Dandachli

Nakhla

Iranpour

et al. 2008

Clin Orthop Relat Res

View full text Add to dashboard Cite

Acetabular center positioning has an effect on hip function. However, reported clinical and plain radiographic methods are inaccurate and unreliable for ascertaining acetabular implant location. In an exploratory study we asked whether the normal acetabular position can be derived from simple radiographically measurable pelvic dimensions. We analyzed computed tomographic scans of 37 normal hips using a pelvic frame of reference centered on the ipsilateral anterior-superior iliac spine. We defined the x-, y-, and z-coordinates of the hip center (C x ,C y ,C z ) as a percentage of the corresponding pelvic dimensions (D x ,D y ,D z ). C x /D x averaged 9%, C y /D y 34%, and C z /D z 37%. These ratios had narrow distributions with small confidence intervals. Interobserver agreement tests showed a mean intraclass correlation coefficient of 0.95. We observed gender differences in the ratios of as much as 4%, which correspond to differences of as much as 9 mm in the hip center position. The ratios provide a simple and reliable way of deriving the normal position of the hip center from the pelvic dimensions alone. This gives the surgeon a simple way of planning where the hip center should be and may be particularly helpful in revision hip arthroplasty or in cases involving extensive osteophytes, dysplasia, or protrusio.

show abstract

Impingement with Total Hip Replacement

Cited by 304 publications

References 62 publications

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

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

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

Can the Acetabular Position be Derived from a Pelvic Frame of Reference?

Contact Info

Product

Resources

About