The Effect of the Orientation of the Acetabular and Femoral Components on the Range of Motion of the Hip at Different Head-Neck Ratios*

D’Lima, Darryl D.; Urquhart, Andrew G.; Buehler, Knute O.; Walker, Richard; Colwell, Clifford W.

doi:10.2106/00004623-200003000-00003

Cited by 446 publications

(281 citation statements)

References 11 publications

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“…The impact of head-neck ratio is not reported here because it has been well documented that increasing the ratio increases ROM [2,5,27]. The results here refer to a 2.33 ratio.…”

Section: Discussionmentioning

confidence: 91%

Compliant positioning of total hip components for optimal range of motion

Widmer

Zurfluh

2004

Journal Orthopaedic Research

499

369

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Impingement between femoral neck and endoprosthetic cup is one of the causes for dislocation in total hip arthroplasty (THA). Choosing a correct combined orientation of both components, the acetabular cup and femoral stem, in manual or computer-assisted implantation will yield a maximized, stable range of motion (ROM) and will reduce the risk for dislocation. A mathematical model of a THA was developed to determine the optimal combination of cup inclination, cup anteversion, and stem antetorsion for maximizing ROM and minimizing the risk for cup-neck impingement. Single and combined hip joint motions were tested. A radiographic definition was used for component orientation. Additional parameters, such as stem-neck (CCD) angle, head-neck ratio, and the design of the acetabular opening, were also considered. The model showed that a maximized and safe ROM requires compliant, well-defined combinations of cup inclination, cup anteversion, and stem antetorsion depending on the intended ROM. Radiographic cup anteversion and stem antetorsion were linearly correlated. Additional internal rotation reduced flexion, and additional external rotation reduced extension, abduction and adduction. The articulating hemispheric surface of acetabular cups should be oriented between 40" and 45" of radiographic inclination, between 20" and 28" of radiographic cup anteversion, and should be combined with stem antetorsion so that the sum of cup anteversion plus 0.7 times the stem antetorsion equals 37". Final component orientation must also consider cup containment, implant impingement with bone and soft tissue, and preoperative skeletal contractures or deformities to achieve the optimal compromise for each patient.

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“…The impact of head-neck ratio is not reported here because it has been well documented that increasing the ratio increases ROM [2,5,27]. The results here refer to a 2.33 ratio.…”

Section: Discussionmentioning

confidence: 91%

Compliant positioning of total hip components for optimal range of motion

Widmer

Zurfluh

2004

Journal Orthopaedic Research

499

369

View full text Add to dashboard Cite

show abstract

“…This may have consequences in a patient with a THA, since there will be no change in the functional anteversion of the acetabular component [29,45]. An increase in functional anteversion of the acetabular component is thought to be protective against posterior dislocation in the sitting position, because it provides more posterior coverage of the prosthetic head [19] and reduces the likelihood of anterior impingement of the prosthetic femoral neck on the edge of the acetabular cup or bone [12]. Our study patients experienced a mean increase in posterior pelvic tilt of 22°from standing to sitting position, which is similar to values reported in previous studies [19,25,35], and this increase in posterior pelvic tilt would increase the functional anteversion of the acetabular component by approximately 15° [29,31].…”

Section: Discussionmentioning

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

193

177

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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

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“…Despite investigators having linked nonideal acetabular inclination angles to increased component wear [4,11,19,23], there is little reported data evaluating the association between acetabular component inclination angles with overall survivorship. We therefore determined: (1) whether the cup inclination angle influence survival or function in patients with ceramic-on-ceramic implants; (2) the incidence of radiolucencies, osteolysis, and subsidence of ceramic-on-ceramic implants; and (3) whether the survival rate higher for ceramic-on-ceramic THAs than for conventional metal-on-polyethylene THAs.…”

Section: Discussionmentioning

confidence: 99%

“…Although authors disagree about recommendations for where the acetabular component should be positioned (for example, some would describe ideal acetabular inclination as 45°± 10°, while others would say 40°± 10°), it is agreed suboptimal acetabular positioning can lead to construct instability and detrimental wear characteristics [4,11,19,23]. Although more horizontal component positioning reportedly reduces the rate of dislocation, there appear to be higher contact stresses when the acetabulum is positioned this way [21,22], which may lead to increased PE wear [10,21,22,30].…”

Section: Introductionmentioning

confidence: 99%

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Johansson

Johnson

Zywiel

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Reports in the literature have linked high acetabular inclination angles to increased wear of ceramicon-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings. Questions/purposes We therefore determined: (1) whether the cup inclination angle influences survival or function in patients with ceramic-on-ceramic implants; (2) the incidence of radiolucencies, osteolysis, and subsidence of ceramic-on-ceramic implants; and (3) whether the survival rate higher for ceramic-on-ceramic THAs than for conventional metal-on-polyethylene THAs.Methods We retrospectively reviewed 537 THAs performed in 512 prospectively followed patients having THA between October 1996 and October 2000. Eleven patients (12 hips) were lost to followup before 2 years, leaving 501 patients (525 THAs); of these, 421 were alumina ceramic-on-ceramic articulations and 104 cobaltchromium-on-polyethylene. The mean age was 54 years. We determined acetabular cup inclination angles, Harris hip scores, Health-Status-Questionnaire-12 scores, and presence and location of any radiolucencies, osteolysis, or radiographic subsidence. We compared survival using the Kaplan-Meier method. The minimum followup was 24 months (mean, 59 months; range, 24-120 months). Results Twenty-two of the 424 THAs (4.2%) were revised. We observed no difference in clinical or radiographic outcomes with respect to cup inclination angles. Radiographically, two loose acetabular components and two femoral components had subsided. The 5-year survival rate was slightly higher for ceramic-on-ceramic bearings (98%) than for metal-on-polyethylene (92%).

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The Effect of the Orientation of the Acetabular and Femoral Components on the Range of Motion of the Hip at Different Head-Neck Ratios*

Cited by 446 publications

References 11 publications

Compliant positioning of total hip components for optimal range of motion

Compliant positioning of total hip components for optimal range of motion

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

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

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