Influence of hip center position, anterior inferior iliac spine morphology, and ball head diameter on range of motion in total hip arthroplasty.
Adult
Aged
Aged, 80 and over
Arthroplasty, Replacement, Hip
/ methods
Computer Simulation
Female
Femur Head
/ diagnostic imaging
Hip Joint
/ diagnostic imaging
Humans
Ilium
/ diagnostic imaging
Male
Middle Aged
Osteoarthritis, Hip
/ diagnosis
Range of Motion, Articular
Tomography, X-Ray Computed
/ methods
Bony impingement
Computer tomography
Range of motion
Total hip arthroplasty
Journal
Orthopaedics & traumatology, surgery & research : OTSR
ISSN: 1877-0568
Titre abrégé: Orthop Traumatol Surg Res
Pays: France
ID NLM: 101494830
Informations de publication
Date de publication:
02 2019
02 2019
Historique:
received:
14
04
2018
revised:
29
08
2018
accepted:
13
09
2018
pubmed:
5
12
2018
medline:
14
1
2020
entrez:
5
12
2018
Statut:
ppublish
Résumé
Acetabular component orientation, such as high placement and femoral head diameter influence joint stability in total hip arthroplasty (THA), wherein anterior inferior iliac spine (AIIS) shape could cause femoro-acetabular impingement. Little is known regarding the combined influence of these parameters, particularly in the context of developmental dysplasia of the hip. Therefore we conducted a computer simulation study based on computed tomography (CT) data to determine whether: (1) AIIS shape, (2) high placement of acetabular cups, and (3) ball head diameter influence the range of motion (ROM) after THA. The decrease in ROM depends on AIIS shape and the ROM decreases even if the femoral head diameter is increased when high placement of acetabular cups. CT data from 14 hips of 14 patients were evaluated. Hips were categorized by Hetsroni classification type I (n=6), type II (n=6), and type III (n=2) depending on AIIS shape. ROM was evaluated using CT-based software. Cups were placed at and 5 and 10mm above the normal hip position. The femoral heads used were 28 (standard simulation), 32, and 36mm in diameter. ROM at impingement was measured under flexion (Flex), internal rotation (IR) at 90° flexion (IR at 90Flex), IR at 45° flexion with a 20° adduction (IR at 45Flex20Add), and external rotation at 10° extension (ER at 10Ext). The mean ROM standard simulation for Flex, IR at 90Flex, IR at 45Flex20Add and ER at 10Ext were: 119.8±5.4°, 31.0±11.3°, 70.0±11.9°, and 33.0±9.7° for type I; 118.5±5.5°, 31.5±2.9°, 71.3±2.2°, and 33.3±3.3° for type II; and 105.5±13.4°, 21.0±15.6°, 61.0±11.3°, and 34.5±2.1° for type III, respectively. There were no significant differences in the ROMs of each type (Flex, p=0.252; IR at 90Flex, p=0.461; IR at 45Flex20Add, p=0.261; and ER at 10Ext, p=0.655). For the high placement of acetabular cups, ROM increase was restricted despite the femoral head diameter increase. Larger femoral head diameters increased ROM, with a lower increase in type III because of bony impingement. ROM decreased with higher cup placement. Expansion effects were minimal, even with larger ball head diameters, and were further decreased in types II and III. Attention should be paid to AIIS shape because bony impingements occur early with higher acetabular cup placement. VI Simulation study.
Sections du résumé
BACKGROUND
Acetabular component orientation, such as high placement and femoral head diameter influence joint stability in total hip arthroplasty (THA), wherein anterior inferior iliac spine (AIIS) shape could cause femoro-acetabular impingement. Little is known regarding the combined influence of these parameters, particularly in the context of developmental dysplasia of the hip. Therefore we conducted a computer simulation study based on computed tomography (CT) data to determine whether: (1) AIIS shape, (2) high placement of acetabular cups, and (3) ball head diameter influence the range of motion (ROM) after THA.
HYPOTHESIS
The decrease in ROM depends on AIIS shape and the ROM decreases even if the femoral head diameter is increased when high placement of acetabular cups.
PATIENTS AND METHODS
CT data from 14 hips of 14 patients were evaluated. Hips were categorized by Hetsroni classification type I (n=6), type II (n=6), and type III (n=2) depending on AIIS shape. ROM was evaluated using CT-based software. Cups were placed at and 5 and 10mm above the normal hip position. The femoral heads used were 28 (standard simulation), 32, and 36mm in diameter. ROM at impingement was measured under flexion (Flex), internal rotation (IR) at 90° flexion (IR at 90Flex), IR at 45° flexion with a 20° adduction (IR at 45Flex20Add), and external rotation at 10° extension (ER at 10Ext).
RESULTS
The mean ROM standard simulation for Flex, IR at 90Flex, IR at 45Flex20Add and ER at 10Ext were: 119.8±5.4°, 31.0±11.3°, 70.0±11.9°, and 33.0±9.7° for type I; 118.5±5.5°, 31.5±2.9°, 71.3±2.2°, and 33.3±3.3° for type II; and 105.5±13.4°, 21.0±15.6°, 61.0±11.3°, and 34.5±2.1° for type III, respectively. There were no significant differences in the ROMs of each type (Flex, p=0.252; IR at 90Flex, p=0.461; IR at 45Flex20Add, p=0.261; and ER at 10Ext, p=0.655). For the high placement of acetabular cups, ROM increase was restricted despite the femoral head diameter increase.
DISCUSSION
Larger femoral head diameters increased ROM, with a lower increase in type III because of bony impingement. ROM decreased with higher cup placement. Expansion effects were minimal, even with larger ball head diameters, and were further decreased in types II and III. Attention should be paid to AIIS shape because bony impingements occur early with higher acetabular cup placement.
LEVEL OF EVIDENCE
VI Simulation study.
Identifiants
pubmed: 30509621
pii: S1877-0568(18)30352-9
doi: 10.1016/j.otsr.2018.09.021
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-28Informations de copyright
Copyright © 2018 Elsevier Masson SAS. All rights reserved.