scholarly journals The impact of functional combined anteversion on hip range of motion: a new optimal zone to reduce risk of impingement in total hip arthroplasty

2021 ◽  
Vol 2 (10) ◽  
pp. 834-841
Author(s):  
Patrick B. O'Connor ◽  
Matthew T. Thompson ◽  
Christina I. Esposito ◽  
Nikola Poli ◽  
James McGree ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Component Position ◽  
Total Hip ◽  
Combined Anteversion ◽  
Spinopelvic Alignment ◽  
Functional Orientation ◽  
Pelvic Position ◽  
The Impact

Aims Pelvic tilt (PT) can significantly change the functional orientation of the acetabular component and may differ markedly between patients undergoing total hip arthroplasty (THA). Patients with stiff spines who have little change in PT are considered at high risk for instability following THA. Femoral component position also contributes to the limits of impingement-free range of motion (ROM), but has been less studied. Little is known about the impact of combined anteversion on risk of impingement with changing pelvic position. Methods We used a virtual hip ROM (vROM) tool to investigate whether there is an ideal functional combined anteversion for reduced risk of hip impingement. We collected PT information from functional lateral radiographs (standing and sitting) and a supine CT scan, which was then input into the vROM tool. We developed a novel vROM scoring system, considering both seated flexion and standing extension manoeuvres, to quantify whether hips had limited ROM and then correlated the vROM score to component position. Results The vast majority of THA planned with standing combined anteversion between 30° to 50° and sitting combined anteversion between 45° to 65° had a vROM score > 99%, while the majority of vROM scores less than 99% were outside of this zone. The range of PT in supine, standing, and sitting positions varied widely between patients. Patients who had little change in PT from standing to sitting positions had decreased hip vROM. Conclusion It has been shown previously that an individual’s unique spinopelvic alignment influences functional cup anteversion. But functional combined anteversion, which also considers stem position, should be used to identify an ideal THA position for impingement-free ROM. We found a functional combined anteversion zone for THA that may be used moving forward to place total hip components. Cite this article: Bone Jt Open 2021;2(10):834–841.

scholarly journals Optimal combined anteversion pattern for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study

2021 ◽  
Author(s):  
Ryo Hidaka ◽  
Kenta Matsuda ◽  
Masaki Nakamura ◽  
Shigeru Nakamura ◽  
Hirotaka Kawano
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Target Range ◽  
Total Hip ◽  
Combined Anteversion ◽  
Significant Difference ◽  
The Absolute ◽  
Prosthetic Impingement

Abstract Background Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA. Methods This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥ 135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups. Results There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P < 0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P < 0.01) were predictors in the ROM (-) group. Conclusions The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

scholarly journals Optimal Combined Anteversion Range for Obtaining a Wider Range of Motion without Prosthetic Impingement after Total Hip Arthroplasty: A Three-dimensional Analysis Study

2021 ◽  
Author(s):  
Ryo hidaka ◽  
Kenta Matsuda ◽  
Masaki Nakamura ◽  
Shigeru Nakamura ◽  
Hirotaka Kawano
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Target Range ◽  
Total Hip ◽  
Combined Anteversion ◽  
Significant Difference ◽  
The Absolute ◽  
Prosthetic Impingement

Abstract Background: Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine’s theory using computed tomography (CT)-based three-dimensional motion analysis after THA.Methods: This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine’s and Widmer’s CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine’s CA and Widmer’s CA. Prosthetic ROM was assessed by Yoshimine’s stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups.Results: There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine’s and Widmer’s CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine’s CA difference (area under the curve [AUC] 0.87, P<0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer’s CA difference (AUC 0.83, P<0.01) were predictors in the ROM (-) group.Conclusions: The target range of Yoshimine’s CA (90.8°±6.0°) and Widmer’s CA values (37.3°±6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

What preoperative factors predict postoperative sitting pelvic position one year following total hip arthroplasty?

2018 ◽  
Vol 100-B (10) ◽  
pp. 1289-1296 ◽  
Author(s):  
J. L. Berliner ◽  
C. I. Esposito ◽  
T. T. Miller ◽  
D. E. Padgett ◽  
D. J. Mayman ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lumbar Lordosis ◽  
Sacral Slope ◽  
Rotational Axis ◽  
Total Hip ◽  
Spinopelvic Alignment ◽  
One Year ◽  
Pelvic Position ◽  
Preoperative Factors

Aims The aims of this study were to measure sagittal standing and sitting lumbar-pelvic-femoral alignment in patients before and following total hip arthroplasty (THA), and to consider what preoperative factors may influence a change in postoperative pelvic position. Patients and Methods A total of 161 patients were considered for inclusion. Patients had a mean age of the remaining 61 years (sd 11) with a mean body mass index (BMI) of 28 kg/m2 (sd 6). Of the 161 patients, 82 were male (51%). We excluded 17 patients (11%) with spinal conditions known to affect lumbar mobility as well as the rotational axis of the spine. Standing and sitting spine-to-lower-limb radiographs were taken of the remaining 144 patients before and one year following THA. Spinopelvic alignment measurements, including sacral slope, lumbar lordosis, and pelvic incidence, were measured. These angles were used to calculate lumbar spine flexion and femoroacetabular hip flexion from a standing to sitting position. A radiographic scoring system was used to identify those patients in the series who had lumbar degenerative disc disease (DDD) and compare spinopelvic parameters between those patients with DDD (n = 38) and those who did not (n = 106). Results Following THA, patients sat with more anterior pelvic tilt (mean increased sacral slope 18° preoperatively versus 23° postoperatively; p = 0.001) and more lumbar lordosis (mean 28° preoperatively versus 35° postoperatively; p = 0.001). Preoperative change in sacral slope from standing to sitting (p = 0.03) and the absence of DDD (p = 0.001) correlated to an increased change in postoperative sitting pelvic alignment. Conclusion Sitting lumbar-pelvic-femoral alignment following THA may be driven by hip arthritis and/or spinal deformity. Patients with DDD and fixed spinopelvic alignment have a predictable pelvic position one year following THA. Patients with normal spines have less predictable postoperative pelvic position, which is likely to be driven by hip stiffness. Cite this article: Bone Joint J 2018;100-B:1289–96.

Differences in range of motion with the same combined anteversion after total hip arthroplasty

2017 ◽  
Vol 42 (5) ◽  
pp. 1021-1028 ◽  
Author(s):  
Takaaki Ohmori ◽  
Tamon Kabata ◽  
Yoshitomo Kajino ◽  
Tadashi Taga ◽  
Kazuhiro Hasegawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Combined Anteversion

The Impact of Total Hip Arthroplasty on Pelvic Motion and Functional Component Position is Highly Variable

2017 ◽  
Vol 32 (4) ◽  
pp. 1200-1205 ◽  
Author(s):  
Denis Nam ◽  
Venessa Riegler ◽  
John C. Clohisy ◽  
Ryan M. Nunley ◽  
Robert L. Barrack
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Component Position ◽  
Functional Component ◽  
Total Hip ◽  
Pelvic Motion ◽  
The Impact

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

2015 ◽  
Vol 39 (12) ◽  
pp. 2323-2333 ◽  
Author(s):  
Markus Weber ◽  
Tim Weber ◽  
Michael Woerner ◽  
Benjamin Craiovan ◽  
Michael Worlicek ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Total Hip ◽  
Combined Anteversion ◽  
One Year ◽  
The Impact

scholarly journals The Impact of Global Spinal Alignment on Standing Spinopelvic Alignment Change After Total Hip Arthroplasty

2021 ◽  
pp. 219256822110266
Author(s):  
Deeptee Jain ◽  
Jonathan M. Vigdorchik ◽  
Edem Abotsi ◽  
Dennis Vasquez Montes ◽  
Edward M. Delsole ◽  
...  
Keyword(s):  
Cohort Study ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
T Test ◽  
Spinal Alignment ◽  
Total Hip ◽  
Spinopelvic Alignment ◽  
The Impact

Study Design: Retrospective cohort study. Objectives: The interactions between hip osteoarthritis (OA) and spinal malalignment are poorly understood. The purpose of this study was to assess the influence of total hip arthroplasty (THA) on standing spinopelvic alignment. Methods: In this retrospective cohort study, patients undergoing THA for OA with pre-and postoperative full-body radiographs were included. Standing spinopelvic parameters were measured. Contralateral hip was graded on the Kellgren-Lawrence scale. Pre-and postoperative alignment parameters were compared by paired t-test. The severity of preoperative thoracolumbar deformity was measured using TPA. Linear regression was performed to assess the impact of preoperative TPA and changes in spinal alignment. Patients were separated into low and high TPA (<20 or >/=20 deg) and change in parameters were compared between groups by t-test. Similarly, the influence of K-L grade, age, and PI were also tested. Results: 95 patients were included (mean age 58.6 yrs, BMI 28.7 kg/m2, 48.2% F). Follow-up radiographs were performed at mean 220 days. Overall, the following significant changes were found from pre-to postoperative: SPT (14.2 vs. 16.1, P = 0.021), CL (−8.9 vs. −5.3, P = .001), TS-CL (18.2 vs. 20.5, P = .037) and SVA (42.6 vs. 32.1, P = .004). Preoperative TPA was significantly associated with the change in PI-LL, SVA, and TPA. High TPA patients significantly decreased SVA more than low TPA patients. There was no significant impact of contralateral hip OA, PI, or age on change in alignment parameters. Conclusion: Spinopelvic alignment changes after THA, evident by a reduction in SVA. Preoperative spinal sagittal deformity impacts this change. Level of evidence: III.

scholarly journals A Specific Anteversion of Cup and Combined Anteversion for Total Hip Arthroplasty Using Lateral Approach

2020 ◽  
Vol 12 (6) ◽  
pp. 1663-1673
Author(s):  
Li Li ◽  
Yu Zhang ◽  
Yuan‐yuan Lin ◽  
Zhen‐xing Li ◽  
Liang Chen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lateral Approach ◽  
Total Hip ◽  
Combined Anteversion

scholarly journals The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

2021 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Tareq Naji ◽  
Florian Fensky ◽  
Frank O. Henes ◽  
Darius M. Thiesen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Mass ◽  
Bone Quality ◽  
Hip Arthroplasty ◽  
Mass Density ◽  
Acetabular Fractures ◽  
Bone Mass Density ◽  
Radiological Outcome ◽  
Total Hip ◽  
The Impact

Abstract Purpose To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. Patients and methods A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. Results Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. Conclusion A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

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