Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement

Kluess, Daniel; Martin, H.; Mittelmeier, Wolfram; Schmitz, Klaus‐Peter; Bader, Rainer

doi:10.1016/j.medengphy.2006.07.001

Cited by 180 publications

(137 citation statements)

References 19 publications

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“…Dislocation following THA is a serious complication. In addition to being very painful and necessitating revision arthroplasty and/or aggressive rehabilitation following closed reduction (38), dislocations are estimated to increase the hospital costs of a primary THA by Ͼ300% (17). Potential explanations for our findings include systematic differences in the size of implants used for patients with RA and those used for patients with OA.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

158

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Objective. Most of the evidence regarding complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are based on patients with osteoarthritis (OA); less is known about outcomes in rheumatoid arthritis (RA). Using a validated algorithm for identifying patients with RA, we undertook this study to compare the rates of complications among THA and TKA recipients between those with RA and those without RA.Methods. In patients who underwent a first primary elective THA or TKA between 2002 and 2009, those with RA were identified using a validated algorithm: a hospitalization with a diagnosis code for RA or 3 physician billing claims with a diagnosis code for RA, with at least 1 claim by a specialist (rheumatologist, orthopedic surgeon, or internist) in a 2-year period. Recipients with diagnostic codes suggesting an inflammatory arthritis, but not meeting RA criteria, were classified as having inflammatory arthritis. All remaining patients were deemed to have OA. Cox proportional hazards models, censored on death, were used to determine the relationship between the type of arthritis and the occurrence of specific complications, adjusting for potential confounders (age, sex, comorbidity, and provider volume).Results. We identified 43,997 eligible THA recipients (3% with RA) and 71,793 eligible TKA recipients (4% with RA). Total joint arthroplasty recipients with RA had higher age and sex-standardized rates of dislocation following THA (2.45%, compared with 1.21% for recipients with OA) and higher age and sex-standardized rates of infection following TKA (1.26%, compared with 0.84% for recipients with OA). Controlling for potential confounders, recipients with RA remained at increased risk of dislocation within 2 years of THA (adjusted hazard ratio [HR] 1.91, P ‫؍‬ 0.001) and remained at increased risk of infection within 2 years of TKA (adjusted HR 1.47, P ‫؍‬ 0.03) relative to recipients with OA.Conclusion. Patients with RA are at higher risk of dislocation following THA and are at higher risk of infection following TKA relative to those with OA. Further research is warranted to elucidate explanations for these findings, including the roles of medication profile, implant choice, postoperative antibiotic protocol, and method of rehabilitation following joint replacement.

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Section: Discussionmentioning

confidence: 99%

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Ravi

Croxford

Hollands

et al. 2014

Arthritis & Rheumatology

158

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“…Patient factors influencing an increased rate of dislocation, liner fracture, and increased wear included body mass index (BMI) [46], age [33,39,47], gender [33,47], and primary diagnosis for the THA [10,47]. Surgical factors influencing these risks include performing surgeon experience [5,47], surgical approach [2,9,13,28,34,47], prosthetic components [3,18,20,22,33,35,47], acetabular cup fixation method [10], and orientation of the acetabular cup [22,33,47]. This project was funded by the Harris Orthopaedic Laboratory.…”

Section: Introductionmentioning

confidence: 99%

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Callanan

Jarrett

Bragdon

et al. 2011

Clinical Orthopaedics &Amp; Related Research

472

406

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Background Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations. Question/purposes We determined the percent of optimally positioned acetabular cups and whether patient and surgical factors affected acetabular component position. Methods We obtained postoperative AP pelvis and crosstable lateral radiographs on 2061 consecutive patients who received a THA or hip resurfacing from 2004 to 2008. One thousand nine hundred and fifty-two hips had AP pelvic radiographs with correct position of the hip center, and 1823 had both version and abduction angles measured. The AP radiograph was measured using Hip Analysis Suite TM to calculate the cup inclination and version angles, using the lateral film to determine version direction. Acceptable ranges were defined for abduction (30°-45°) and version (5°-25°).Results From the 1823 hips, 1144 (63%) acetabular cups were within the abduction range, 1441 (79%) were within the version range, and 917 (50%) were within the range for both. Surgical approach, surgeon volume, and obesity (body mass index [ 30) independently predicted malpositioned cups.

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“…As seen in previous studies [6,13], postoperative stability of THA relies on the relative orientation of the cup with respect to the stem. Guidelines have been published, but most are static recommendations in local reference systems.…”

Section: Discussionmentioning

confidence: 70%

“…Postoperative stability of THA is the consequence of acetabular and femoral implant orientations, balance of soft tissues, and restored leg length and offset [1,6,13]. Despite much work to enhance implant orientation, some studies report a residual rate of dislocation from 1% to as much as 6% [6,18].…”

Section: Introductionmentioning

confidence: 99%

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Toward a Dynamic Approach of THA Planning Based on Ultrasound

Dardenne

Dusseau

Hamitouche

et al. 2008

Clin Orthop Relat Res

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The risk of dislocation after THA reportedly is minimized if the acetabular implant is oriented at 45°i nclination and 15°anteversion with respect to the anterior pelvic plane. This reference plane now is used in computerassisted protocols. However, this static approach may lead to postoperative instability because the dynamic variations of the pelvis influence effective cup orientation and are not taken into account in this approach. We propose an ultrasound tool to register the preoperative dynamics of the pelvis for THA planning during computer-assisted surgery. To assess this pelvic behavior and its consequences on implant orientation, we tested a new 2.5-dimensional ultrasound-based approach. The pelvic flexion was registered in sitting, standing, and supine positions in 20 subjects. The mean values were -25.2°± 5.8°(standard deviation), 2.4°± 5.1°, and 6.8°± 3.5°, respectively. The mean functional anteversion varied by 26°and the mean functional inclination by 12°depending on the pelvic flexion. We therefore recommend including dynamic pelvic behavior to minimize dislocation risk. The notion of a safe zone should be revisited and extended to include changes with activity.

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Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement

Cited by 180 publications

References 19 publications

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

Increased Risk of Complications Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Toward a Dynamic Approach of THA Planning Based on Ultrasound

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