Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?

Introduction: There is a trend for increasing use of dual mobility hip designs for both primary and revision hip arthroplasty settings. It provides dual articular surfaces along with increased jump distance to increase the stability of construct. However, this design has some unique complications of its own which surgeons should be aware of especially intraprosthetic dislocation (IPD). Case Report: A 76-year-old lady presented to clinic with painful hip hemiarthroplasty after fracture neck of femur. She underwent revision surgery with dual mobility uncemented acetabular cup and femoral stem was retained as it was well fixed. She was mobilizing well and around 5 weeks post her surgery, developed pain in hip region and difficulty in weight-bearing. Radiographs showed eccentric position of femoral neck in the socket. A diagnosis of IPD was established and revision surgery was planned. Intraoperatively, metal head had dislocated from the polyethylene head and both components were resting in the acetabular socket. No macroscopic erosion of acetabulum was noticed. The polyethylene component and femoral head were retrieved. With previous failed dual mobility, decision was made to achieve stability with larger head size and lipped liner posteriorly. Conclusion: IPD is a rare occurrence and unique complication to dual mobility implants. This report highlights that patients can have IPD without fall or trauma. Keywords: Intraprosthetic dislocation, dual mobility cup, dislocation, total hip replacement.

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Effect of Biomechanical and Anatomic Characteristics on Patient-Reported Outcomes Following Total Hip Arthroplasty

Proceedings of IMPRS ◽

10.18060/23567 ◽

2019 ◽

Vol 2 (1) ◽

Author(s):

Lauren Pitz, BS ◽

Braeden W. Estes, BS ◽

Evan R. Deckard, BSE ◽

R. Michael Meneghini, MD

Keyword(s):

Total Hip Arthroplasty ◽

Femoral Stem ◽

Activity Level ◽

Lumbar Pain ◽

Leg Length ◽

Acetabular Cup ◽

Femoral Offset ◽

Primary Thas ◽

Patient Reported ◽

High Bmi

Background and Hypothesis: The success of total hip arthroplasty (THA) is often reported in terms of infection and dislocation rates. While studies have examined the effect of acetabular cup position, anteroposterior (AP) femoral stem alignment, changes in leg length and femoral stem offset on dislocation rates, few studies have investigated the effect of these biomechanical parameters on patient-reported outcome measures (PROMS). The purpose of this study was to evaluate how PROMS may differ by THA component placement in a consecutive series of primary THAs. Awareness of the importance of implant positioning may lead to improved surgical technique and optimized PROMS. Experimental Design or Project Methods: 933 consecutive posterolateral approach primary THAs performed between 2011 and 2018 by one surgeon were retrospectively reviewed. Acetabular cup abduction, femoral stem alignment, changes in leg length and total femoral offset were measured on APview radiographs. Prospectively collected Hip Disability and Osteoarthritis Outcome Score/HOOS Jr., University of California Los Angeles/UCLA Activity Level, and satisfaction (5-point Likert scale) were evaluated at minimum one-year. Results: 743 THAs were analyzed. Mean age and BMI were 64 years and 31 kg/m2, respectively. After multivariate analysis, females with neutral to valgus stem placement (p=0.020) and patients with neutral to valgus stem placement regardless of lumbar pain (p=0.034) were more satisfied. In addition, patients with lumbar pain (p<0.001) and patients with high BMI in combination with increased change in femoral offset (p=0.056) had lower overall HOOS Jr. scores. Interestingly, change in leg length was not a significant predictor of any PROMS (power [1-β]≥88.4%). Conclusion and Potential Impact: AP stem alignment may play a role in increased activity level and satisfaction. In addition, high BMI in combination with increased change in femoral offset negatively influenced HOOS Jr. scores. Unsurprisingly, the presence of lumbar pain continues to negatively affect PROMS. Further research is warranted on the influence of THA component placement, spinopelvic parameters, and PROMS.

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Current methods of preventing aseptic loosening and improving osseointegration of titanium implants in cementless total hip arthroplasty: a review

Journal of International Medical Research ◽

10.1177/0300060517732697 ◽

2017 ◽

Vol 46 (6) ◽

pp. 2104-2119 ◽

Cited By ~ 32

Author(s):

Dragos Apostu ◽

Ondine Lucaciu ◽

Cristian Berce ◽

Dan Lucaciu ◽

Dan Cosma

Keyword(s):

Aseptic Loosening ◽

Hip Arthroplasty ◽

Psychotic Disorders ◽

Femoral Stem ◽

Hip Osteoarthritis ◽

Titanium Implants ◽

Good Survival ◽

Acetabular Cup ◽

Implant Surface ◽

Stem Design

Hip osteoarthritis is the most common joint disorder, and is represented by a degenerative process, resulting in pain and functional impairment. If conservative treatment for hip osteoarthritis fails, the only remaining option is hip arthroplasty. Despite good survival of implants, loosening of components is the most common complication. This leads to revision surgeries, which are technically demanding, expensive, and result in a low satisfaction rate. Uncemented hip replacements require proper osseointegration for increased survival. Physical characteristics of implants include biocompatibility, Young’s modulus of elasticity, strength, and corrosion resistance, and each influence fixation of implants. Moreover, implant surface treatments, pore size, pore density, and femoral stem design should be appropriately selected. Patients’ optimization of obesity, osteoporosis, cardiovascular disease, psychotic disorders, and smoking cessation are associated with a higher survival of implants. Surgical factors, such as approach, drilling and rasping, acetabular bone coverage, acetabular cup positioning, and implant size, also affect survival of implants. Avoiding drugs, which may impair osseointegration of implants, and having an appropriate rehabilitation protocol are important. Future directions include anabolic and anti-catabolic bone-acting drugs to enhance osseointegration of implants. Comprehensive knowledge of the factors mentioned above is important for preventing aseptic loosening, with important socioeconomic consequences.

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Assessment of an Orthopaedic Templating Software Package for Cemented Total Hip Arthroplasty

The Journal of Hip Surgery ◽

10.1055/s-0039-1678746 ◽

2019 ◽

Vol 03 (02) ◽

pp. 059-061

Author(s):

Michael Newman ◽

Grant Shaw ◽

Timothy Kane

Keyword(s):

Femoral Stem ◽

Femoral Prosthesis ◽

Acetabular Cup ◽

Total Hip ◽

Pelvic Radiograph ◽

Tapered Stem ◽

Hip Arthroplasties ◽

Cemented Total Hip Arthroplasty ◽

Operating Surgeon ◽

Insight Into

AbstractThe main aim of this article was to assess a large, multisurgeon dataset of cemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size, (2) offset, and (3) acetabular cup size. A database of total hip arthroplasties performed by four surgeons between the dates November 7, 2014 and October 31, 2017 was interrogated. The data was refined so that only primary cemented collarless polished tapered stem hip arthroplasties, fully templated on a correctly calibrated pelvic radiograph, were included. This provided 354 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stem, the software was exactly correct in 70.9% and accurate to within one size in 96.89% of cases. With regard to the femoral offset, the software was exactly correct in 87.01% and accurate to within one size in 99.72% of cases. With regard to the acetabular cup size, the software was exactly correct in 61.3% and accurate to within +/− 2 mm in 87.29% of cases. Templating software offers an accurate prediction of the femoral prosthesis size and offset, as well as acetabular cup size. Preoperative insight into likely component sizes and offset provides the operating surgeon with many benefits; templating the pelvic radiograph is a method of cognitive rehearsal, provides insight into potentially challenging aspects of the upcoming surgery, may highlight intraoperative issues where there is a large intraoperative deviation from what is templated, and enables efficient stock keeping for the healthcare institution.

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Failure of an Uncemented Press-Fit Acetabular Cup in Primary Total Hip Arthroplasty

Hip International ◽

10.1177/112070000201200404 ◽

2002 ◽

Vol 12 (4) ◽

pp. 371-377 ◽

Cited By ~ 1

Author(s):

N. Rama Mohan ◽

P. Grigoris ◽

D.L. Hamblen

Keyword(s):

Femoral Stem ◽

Acetabular Cup ◽

Total Hip ◽

Press Fit ◽

Total Hip Replacements ◽

Locking Mechanism ◽

Hip Replacements ◽

The Mean ◽

Open Position ◽

Primary Total Hip Arthroplasty

We reviewed fifteen primary total hip replacements performed using the uncemented, non-porous coated press-fit AcSys Shearer Cup. A modular titanium straight femoral stem with a 32mm head was used in all cases. The mean age of the group containing five males and 10 females was 66 years. Eight cups have been revised for aseptic loosening at a mean of seven years and the remaining four cups are radiologically loose. At revision surgery none of the cups showed any evidence of bony ingrowth. Our 10-year results with this cup indicate an unacceptably high failure rate of 80%. Absence of bony ingrowth and the lack of a secure locking mechanism between the polyethylene liner and the metal shell are the most important causes of failure. The use of a 32mm diameter head and implantation of the cup in an open position contributed to this failure. Even though this cup is no longer manufactured, our experience suggests that all non-porous coated cups should be closely followed up.

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Intrapelvic Migration of a Well-Fixed Femoral Stem After Removal of an Acetabular Cup

The Journal of Arthroplasty ◽

10.1016/j.arth.2005.07.022 ◽

2006 ◽

Vol 21 (6) ◽

pp. 922-925 ◽

Cited By ~ 9

Author(s):

Mohamed Shafi ◽

Weon-Yoo Kim ◽

Chang Hwan Han ◽

Jong-Hoon Ji ◽

Sang-Myung Lee

Keyword(s):

Femoral Stem ◽

Acetabular Cup

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Examination of Alumina Ceramic Components from Total Hip Arthroplasties

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/pime_proc_1993_207_288_02 ◽

1993 ◽

Vol 207 (3) ◽

pp. 155-162 ◽

Cited By ~ 35

Author(s):

A B Nevelös ◽

P A Evans ◽

P Harrison ◽

M Rainforth

Keyword(s):

Wear Debris ◽

Femoral Stem ◽

Surface Wear ◽

Acetabular Cup ◽

Materials Analysis ◽

Total Hip ◽

Ceramic Components ◽

Initiation Stage ◽

Articulating Surface ◽

Hip Arthroplasties

Materials analysis has been conducted on retrieved Mittelmeier-Autophor ceramic components from total hip arthroplasties, correlating articulating surface wear morphology with clinical reasons for failure. Plastically deformed, agglomerated wear debris (30–60 μm) has been identified on femoral head articulation wear surfaces, displaying exaggerated wear, especially during the initiation stage. Such surfaces were associated with clinical failures involving displacement of the acetabular cup and perforation of the cortex by the femoral stem, It is thought that this wear debris may play an important role in the promotion of the ‘avalanche’ wear mechanism, as it is adherent and thus difficult to remove from the wear interface

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Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.3089 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Engin Çarkçı ◽

Ayse Esin Polat ◽

Yusuf Öztürkmen ◽

Tolga Tüzüner

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Survival Rates ◽

Femoral Stem ◽

Long Term Results ◽

Harris Hip Score ◽

Acetabular Cup ◽

Total Hip ◽

Kaplan Meier

Objective: In this study we aimed to investigate the long-term clinical and radiological results, revision rates and causes, and the rate of implant survival in total hip arthroplasty performed using CLS® expansion cup and Spotorno® cementless femoral stem. Methods: Clinical results of total hip arthroplasty performed on 131 hips of 114 patients in Istanbul Training and Research Hospital between 1993 and 2003 were retrospectively evaluated according to the Harris Hip Score. Revision rates were determined and implant survival rates were identified using the Kaplan-Meier estimator. Results: Of the patients, 39 were males and 75 were females. The average age of the patients at surgery was 48.7±11.3 years. Patients were followed up for a mean period of 13.9±2.4 years. The mean Harris Hip Score was 34.35±6.09 preoperatively and 88.20±7.11 at the final follow-up (p<0.001). The Kaplan-Meier survivorship estimate for the cup at 13.9 years, taking revision for any reason as the end point was 95.6% (95% CI), while the 15th and 17th year survival rates were 90% and 85%, respectively. Conclusion: In total hip arthroplasty using a cementless expansive acetabular cup, a 95.6% survival rate is achieved after an average of 14 years, whereas the rate decreases to 85% after 17 years. Even if the incidence of cup breakage is reduced with proper implantation, particle disease and periacetabular osteolysis remains a problem for the long-term survival. doi: https://doi.org/10.12669/pjms.37.1.3089 How to cite this:Carkci E, Polat AE, Ozturkmen Y, Tuzuner T. Long-Term results of total Hip Arthroplasty performed using a cementless expansive Acetabular Cup and Spotorno Femoral Stem. Pak J Med Sci. 2021;37(1):52-58. doi: https://doi.org/10.12669/pjms.37.1.3089 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Value of 3D Preoperative Planning for Primary Total Hip Arthroplasty Based on Artificial Intelligence Technology

10.21203/rs.3.rs-120578/v1 ◽

2020 ◽

Author(s):

Jiabang Huo ◽

Guangxin Huang ◽

Dong Han ◽

Xinjie Wang ◽

Yufan Bu ◽

...

Keyword(s):

Artificial Intelligence ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Acetabular Dysplasia ◽

Preoperative Planning ◽

Femoral Stem ◽

Acetabular Cup ◽

Component Size ◽

Total Hip ◽

Digital Template

Abstract Background: Accurate preoperative planning is an important step for accurate reconstruction in total hip arthroplasty (THA). Presently, preoperative planning is completed using either a two-dimensional (2D) template or three-dimensional (3D) mimics software. With the development of artificial intelligence (AI) technology, AI HIP, a planning software based on AI technology can quickly and automatically identify acetabular and femur morphology, and automatically match the optimal prosthesis size. However, the accuracy and feasibility of its clinical application still needs to be further verified. The purposes of this study were to investigate the accuracy and time efficiency of AI HIP in preoperative planning for primary THA, compared with 3D mimics software and 2D digital template; and further analyze the factors that influence the accuracy of AI HIP.Methods: A prospective study was conducted on 53 consecutive patients (59 hips) undergoing primary THA with cementless prostheses in our department. All preoperative planning was completed using AI HIP as well as 3D mimics and 2D digital template. The predicted component size and the actual implantation results were compared to determine the accuracy. The templating time was compared to determine the efficiency. Furthermore, the potential factors influencing the accuracy of AI HIP were analyzed including sex, body mass index (BMI), and hip dysplasia.Results: The accuracy in predicting the acetabular cup and femoral stem was 74.58% and 71.19%, respectively, for AI HIP; 71.19% (P = 0.743) and 76.27% (P = 0.468), respectively, for 3D mimics; 40.68% (P < 0.001) and 49.15% (P = 0.021), respectively, for 2D digital templating. The templating time using AI HIP was 3.91±0.64 min, which was equivalent to 2D digital templates (2.96±0.48 min, P < 0.001), but shorter than 3D mimics (32.07±2.41 min, P < 0.001). Acetabular dysplasia(P = 0.021), rather than sex and BMI, was an influential factor in the accuracy of AI HIP templating. Compared to patients with developmental dysplasia of the hip (DDH), the accuracy of acetabular cup in the non-DDH group was better (P = 0.021), but the difference in the accuracy of the femoral stem between the two groups was statistically insignificant (P = 0.062).Conclusion: AI HIP showed excellent reliability for component size in THA. Acetabular dysplasia may affect the accuracy of AI HIP templating.

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The accuracy of digital templating in cementless total hip arthroplasty in dysplastic hips

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04793-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Emelie Kristoffersson ◽

Volker Otten ◽

Sead Crnalic

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Developmental Dysplasia ◽

Leg Length ◽

Acetabular Cup ◽

Digital Templating ◽

Total Hip ◽

Implant Size ◽

Crowe Classification

Abstract Background Total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH) is a complex procedure due to associated anatomical abnormalities. We studied the extent to which preoperative digital templating is reliable when performing cementless THA in patients with DDH. Methods We templated and compared the pre- and postoperative sizes of the acetabular and femoral components and the center of rotation (COR), and analysed the postoperative cup coverage, leg length discrepancy (LLD), and stem alignment in 50 patients (56 hips) with DDH treated with THA. Results The implant size exactly matched the template size in 42.9% of cases for the acetabular component and in 38.2% of cases for the femoral component, whereas the templated ±1 size was used in 80.4 and 81.8% of cases for the acetabular and femoral components, respectively. There were no statistically significant differences between templated and used component sizes among different DDH severity levels (acetabular cup: p = 0.30 under the Crowe classification and p = 0.94 under the Hartofilakidis classification; femoral stem: p = 0.98 and p = 0.74, respectively). There were no statistically significant differences between the planned and postoperative COR (p = 0.14 horizontally and p = 0.52 vertically). The median postoperative LLD was 7 (range 0–37) mm. Conclusion Digital preoperative templating is reliable in the planning of cementless THA in patients with DDH.

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