The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty

Weber, Markus; Weber, Tim; Woerner, Michael; Craiovan, Benjamin; Worlicek, Michael; Winkler, Sebastian; Grifka, Joachim; Renkawitz, Tobias

doi:10.1007/s00264-015-2777-8

Cited by 17 publications

(5 citation statements)

References 38 publications

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“…Based on the manually segmented bone models, a custom made 360° hip ROM analysis was performed by a previously described algorithm which automatically determines osseous and prosthetic impingement by virtually moving the leg until a collision between the 3D objects occurs 2,13,17 . The high accuracy of this 3D-CT method with deviations in ROM measurements of 1° was demonstrated in a previous study 16,18 . For every single patient ROM analysis was performed twice, first using the implanted stem geometry and second after replacing the original stem with the other offset configuration either standard or HO.…”

Section: Methodsmentioning

confidence: 54%

Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion

Weber

Merle

Nawabi

et al. 2020

Sci Rep

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Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided. Although total hip arthroplasty (THA) is a highly successful treatment option for end-stage osteoarthritis with a positive responder rate of over 90% 1, the surgeon is faced with high patients' expectations regarding the functional capacity of the artificial hip joint. Beside a correct intraoperative orientation of both cup and stem, restoration of biomechanics such as offset is crucial for optimal function and long-term outcome after THA 2-4. Failure of correct offset restoration is associated with impingement, reduced hip abductor strength, altered gait kinematics and even higher wear of the artificial hip joint 5-8. To address the interindividual variability of the femoral anatomy, most modern implant systems offer at least two different offset geometries of the femoral stem-a standard offset design and a high offset design 9. Prior to surgery the biomechanical restoration of offset is usually templated on radiographs illustrating the preferred stem design for the respective patient. However, intraoperative alterations in relation to the preoperative plan or reduced joint stability harbour the potential to complicate the right choice of femoral offset design during THA. The discussion of correlation between high offset (HO) stems and higher range of motion (ROM) is controversial in literature. Although aiming to find the balance between the risks of impingement due to offset reduction on the one hand and po...

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Section: Methodsmentioning

confidence: 54%

Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion

Weber

Merle

Nawabi

et al. 2020

Sci Rep

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“…In some of these patients a limited posterior pelvic tilt in sitting position may induce less anterior uncovering of the acetabulum and less posteroinferior coverage which may lead to anterior impingement and posterior dislocation in sitting position [30]. Ultimately, the effect of this postural changes on the gait needs to be studied may not significantly affect the gait pattern clinically similar to other investigations regarding the gait changes after THA [31,32].…”

Section: Discussionmentioning

confidence: 93%

How do global sagittal alignment and posture change after total hip arthroplasty?

Youngwoo

Pour

Lazennec

2019

International Orthopaedics (SICOT)

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Background Postural change after total hip arthroplasty (THA) is still a matter of discussion. Previous studies have mainly concentrated on the pelvic motions. We report the post-operative changes of the global sagittal posture using pelvic, spinal, and lower extremities parameters. Methods 139 patients (primary THA, without previous spinal or lower extremity surgery) were included. We measured pelvic parameters [SS, sacral slope; PI, pelvic incidence; PT, pelvic tilt; APP angle, anterior pelvic plane angle] and the global posture parameters (SVA, sagittal vertical angle; GSA, global sagittal angle; TPA, T1 pelvic angle). Patients were categorized into low PI group < 45°, 45°< medium PI < 65°, and high PI > 65°. Results Mean GSA and SVA decreased post-operatively (p = 0.005 and p = 0.004 respectively). The TPA change was not significant (p = 0.078). In the low PI group, GSA (5.4 ± 5.0 to 4.3 ± 4.0, p = 0.005) and SVA (5.4 ± 4.9 to 4.2 ± 4.1, p = 0.038) decreased with more posterior pelvic tilt. Post-operative TPA was significantly higher (8.4 ± 10.6 to 9.8 ± 10.7; p = 0.048). In the medium PI group, SVA decreased (4.2 ± 4.6 to 3.6 ± 4.5, p = 0.020) with more posterior pelvic tilt. In the high PI group, pelvic and global posture parameters did not evolve significantly. Conclusion PI is the key determining factor in pelvic tilt modification after THA. Patients with low PI demonstrate significant modification in spine, pelvic, and lower extremities. Pelvic tilt is the main adaptation mechanism for medium incidence patients whereas pelvic tilt does not change in high PI patients after surgery.

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“…The purpose of the primary study was to assess whether the artificial joint's ROM can be improved by computer-assisted, functional optimization of cup position and containment [19]. In addition to combined anteversion measurements [23], the navigation system independently detected protrusion of the cup above the anterior acetabular rim.…”

Section: Methodsmentioning

confidence: 99%

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

Weber

Woerner

Messmer

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Iliopsoas tendon impingement is one possible reason for persistent groin pain and diminished functional outcome after THA. So far, estimation by eye and palpation is the standard procedure to intraoperatively assess the distance of the cup to the anterior rim. However, novel technologies such as imageless navigation enable intraoperative measurements of the cup in relation to the psoas tendon and bony landmarks. Questions/purposes We asked whether psoas impingement (1) can be reduced using imageless navigation compared with the standard technique and (2) is associated with specific patient characteristics. Furthermore, we investigated (3) if anterior cup protrusion (overhang) is associated with lower outcome scores for pain and function.Methods The current study is a reanalysis of data from a randomized controlled trial evaluating navigation for THA; 135 patients were randomized for surgery with or without the use of imageless navigation. The risk for anterior protrusion of the cup above the acetabular rim and thus potential psoas impingement, defined as an overhang of the cup above the anterior acetabular rim as measured on postoperative CT, was either controlled with the help of navigation or standard control by eye and palpation intraoperatively. Postoperatively, the anterior protrusion of the cup above the acetabular rim was measured on three-dimensional (3-D) CT by a blinded, external institute. In addition to patient-related outcome measures, the Harris hip score, Hip disability and Osteoarthritis Outcome Score, and EuroQol were obtained 1 year postoperatively. Altogether 123 data sets were available for primary analysis and 115 were available for 1-year followup. Results There was no difference, with the numbers available, between the navigated and the control groups in terms of the mean distance of the cup below the anterosuperior acetabular rim (3.9 mm; À5.3 to 12.6 mm versus 4.4 mm; À7.9 to 13.7 mm; p = 0.72) or the anteroinferior acetabular rim (4.7 mm; À6.2 to 14.8 mm versus 4.2 mm; À7.1 to 16.3 mm; p = 0.29). There was no difference, with the numbers available, in terms of the proportion of cups with anterior overhang (7%, four of 57 versus, 15%, 10 of 66; p = 0.16), respectively. After controlling for potential confounding variables such as cup inclination, cup size, patient age, BMI, stage of arthritis, and length of skin incision, we found cup anteversion (hazard ratio [HR], 0.87; 95% CI, 0.81-0.93; p \ 0.001) and female sex (HR, 3.88; 95% CI, 1.01-14.93; p = 0.049) were associated with a propensity to potential psoas impingement. With the numbers available, there were no differences observed in

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The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty

Abstract: Standard combined cup and stem anteversion rules do not improve postoperative outcome as measured by gait analysis and clinical scores within one year after THA.

Cited by 17 publications

References 38 publications

Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion

Inaccurate offset restoration in total hip arthroplasty results in reduced range of motion

How do global sagittal alignment and posture change after total hip arthroplasty?

Navigation is Equal to Estimation by Eye and Palpation in Preventing Psoas Impingement in THA

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