scholarly journals Effects of Acetabular Cup Orientation and Implant Design on Psoas Impingement in Total Hip Arthroplasty

2019 ◽  
Vol 9 ◽  
Author(s):  
Michael Ries ◽  
Ahmad Faizan ◽  
Jingwei Zhang ◽  
Laura Scholl
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Psoas Muscle ◽  
Tendon Sheath ◽  
Implant Design ◽  
Acetabular Cup ◽  
Steel Cable ◽  
Total Hip ◽  
Solid Models ◽  
Cup Position

Background:  Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA).    However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain.  The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.Methods:  THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle.  CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design. Results:  The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect.  The distance was greater for the offset head center cup in comparison to the hemispheric cup.  Our results indicate that psoas impingement is related to both cup position and implant geometry. Conclusions:  For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect.   An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry. 

scholarly journals Acetabular cup position and risk of dislocation in primary total hip arthroplasty

2016 ◽  
Vol 88 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Kurt G Seagrave ◽  
Anders Troelsen ◽  
Henrik Malchau ◽  
Henrik Husted ◽  
Kirill Gromov
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Cup Position ◽  
Acetabular Cup Position ◽  
Primary Total Hip Arthroplasty

scholarly journals Acetabular cup position differs in spinopelvic mobility types: a prospective observational study of primary total hip arthroplasty patients

2021 ◽  
Author(s):  
Henryk Haffer ◽  
Zhen Wang ◽  
Zhouyang Hu ◽  
Christian Hipfl ◽  
Matthias Pumberger
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Sacral Slope ◽  
Acetabular Cup ◽  
Sagittal Vertical Axis ◽  
Total Hip ◽  
Spinal Segments ◽  
Cup Positioning ◽  
Cup Position ◽  
Acetabular Cup Position

Abstract Introduction Spinopelvic mobility was identified as a contributing factor for total hip arthroplasty (THA) instability. The influence of spinopelvic function on acetabular cup positioning has not yet been sufficiently investigated in a prospective setting. Therefore, our study aimed (1) to assess cup inclination and anteversion in standing and sitting based on spinopelvic mobility, (2) to identify correlations between cup position and spinopelvic function, (3) and to determine the influence of the individual spinal segments, spinal sagittal balance, and spinopelvic characteristics on the mobility groups. Materials and methods A prospective study assessing 197 THA patients was conducted with stereoradiography in standing and sitting position postoperatively. Two independent investigators determined cup anteversion and inclination, C7-Sagittal vertical axis, cervical lordosis (CL), thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope, pelvic tilt (PT), anteinclination (AI), and pelvic femoral angle (PFA). Spinopelvic mobility is defined based on ∆PT = PTstanding − PTsitting as ∆PT < 10° stiff, ∆PT ≥ 10–30° normal, and ∆PT > 30° hypermobile. Pearson coefficient represented correlations between the cup position and spinopelvic parameters. Results Significant differences were demonstrated for cup anteversion (stiff/hypermobile 29.3°/40.1°; p < 0.000) and inclination (stiff/hypermobile 43.5°/60.2°; p < 0.000) in sitting, but not in standing position. ∆ (standing/sitting) of the cup anteversion (stiff/neutral/hypermobile 5.8°/12.4°/19.9°; p < 0.000) and inclination (stiff/neutral/hypermobile 2.3°/11.2°/18.8°; p < 0.000) revealed significant differences between the mobility groups. The acetabular cup position in sitting, was correlated with lumbar flexibility (∆LL) and spinopelvic mobility. Significant differences were detected between the mobility types and acetabular orientation (AI sit:stiff/hypermobile 47.6°/65.4°; p < 0.000) and hip motion (∆PFA:stiff/hypermobile 65.8°/37.3°; p < 0.000). Assessment of the spinal segments highlighted the role of lumbar flexibility (∆LL:stiff/hypermobile 9.9°/36.2°; p < 0.000) in the spinopelvic complex. Conclusion The significantly different acetabular cup positions in sitting and in the ∆ between standing and sitting and the significantly altered spinopelvic characteristics in terms of stiff and hypermobile spinopelvic mobility underlined the consideration for preoperative functional radiological assessment. Identifying the patients with altered spinopelvic mechanics due to a standardized screening algorithm is necessary to provide safe acetabular cup positioning. The proximal spinal segments appeared not to be involved in the spinopelvic function.

scholarly journals Trends In Cup Position Utilizing Computer-Assisted Navigation During Total Hip Arthroplasty

10.29007/jn8x ◽  
2019 ◽  
Author(s):  
Rachel Mays ◽  
Jessica Benson ◽  
Jeffrey Muir ◽  
Peter White ◽  
Morteza Meftah
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lateral Approach ◽  
Computer Assisted ◽  
Acetabular Cup ◽  
Assisted Navigation ◽  
Total Hip ◽  
Current Mass ◽  
The Mean ◽  
Cup Position

Proper positioning of the acetabular cup deters dislocation after total hip arthroplasty (THA). The concept of a safe zone (SZ) for acetabular component placement was first characterized by Lewinnek et al. and furthered by Callanan et al. The SZ concept remains widely utilized and accepted in contemporary THA practice; however, components positioned in this SZ still dislocate. This study sought to characterize current mass trends in cup position identified across a large study sample of THA procedures completed by multiple surgeons. This retrospective, observational study reviewed acetabular cup position in 1,236 patients who underwent THA using computer-assisted navigation between July 2015 and November 2017. The overall mean cup position of all recorded cases was 21.8° (±7.7°, 95% CI = 6.7°, 36.9°) of anteversion and 40.9° (±6.5°, 95% CI = 28.1°, 53.7°) of inclination. For both anteversion and inclination, 65.5% (809/1236) of acetabular cup components were within the Lewinnek SZ and 58.4% (722/1236) were within the Callanan SZ. Acetabular cups were placed a mean of 6.8° of anteversion (posterior/lateral approach: 7.0°, anterior approach: 5.6°) higher than the Lewinnek and Callanan SZs whereas inclination was positioned 0.9° higher than the reported Lewinnek SZ and 3.4° higher than the Callanan SZ. Our data shows that while the majority of acetabular cups were placed within the traditional SZs, the mean anteversion orientation is considerably higher than those suggested by the Lewinnek and Callanan SZs. The implications of this observation warrant further investigation.

Effect of Acetabular Cup Position and Orientation in Cemented Total Hip Arthroplasty

2001 ◽  
Vol 388 ◽  
pp. 135-142 ◽  
Author(s):  
Kazuo Hirakawa ◽  
Naoto Mitsugi ◽  
Tomihisa Koshino ◽  
Tomoyuki Saito ◽  
Yasusuku Hirasawa ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Position And Orientation ◽  
Cemented Total Hip Arthroplasty ◽  
Cup Position ◽  
Acetabular Cup Position

Undetected Intraoperative Pelvic Movement Can Lead to Inaccurate Acetabular Cup Component Placement during Total Hip Arthroplasty: A Mathematical Simulation Estimating Change in Cup Position

2017 ◽  
Vol 01 (04) ◽  
pp. 186-193 ◽  
Author(s):  
Jonathan Vigdorchik ◽  
Aaron Buckland ◽  
Ameer Elbuluk ◽  
Alex Alguire ◽  
Joseph Schipper ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Pelvic Obliquity ◽  
Acetabular Cup ◽  
Total Hip ◽  
Increased Risk ◽  
Pelvic Movement ◽  
Induced Changes ◽  
Intraoperative Movement ◽  
Cup Position

AbstractIntraoperative patient movement is a common but underappreciated phenomenon in total hip arthroplasty (THA). Such movement can significantly affect the accuracy with which the acetabular cup component is implanted. To evaluate the effect of intraoperative movement on cup position, we performed a study using mathematical modeling to simulate intraoperative movement. Mathematical simulations were used to simulate pelvic movements during THA. Pelvic axial rotation, tilt, and obliquity were simulated, and the resulting changes in intended cup position were calculated. The rate of change of inclination and anteversion per degree of pelvic movement was calculated, establishing a ratio relating cup angle sensitivity to pelvic movement. These sensitivities were used to construct nomograms showing the per-degree effect of pelvic movement on cup position. The effect of pelvic movement on cup position was multifactorial and dependent on the intended cup orientation. For a cup intended to be inserted at 15° anteversion and 40° inclination, each degree of pelvic rotation induced changes of 0.64° and –0.20°, respectively. For this same cup orientation, each degree of pelvic tilt induced changes of 0.77° for anteversion and 0.17° for inclination. Pelvic obliquity was associated with a 1:1 ratio with inclination, with each degree of obliquity inducing 1° of change in inclination. Anteversion was unaffected by changes in pelvic obliquity. This study demonstrates the consequences of undetected pelvic movement on cup position, including the increased risk of the acetabular component being placed in an orientation that could increase wear or the likelihood of impingement and dislocation.

CT-based automated planning of acetabular cup for total hip arthroplasty (THA) based on hybrid use of two statistical atlases

2016 ◽  
Vol 11 (12) ◽  
pp. 2253-2271 ◽  
Author(s):  
Yoshiyuki Kagiyama ◽  
Itaru Otomaru ◽  
Masaki Takao ◽  
Nobuhiko Sugano ◽  
Masahiko Nakamoto ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Automated Planning ◽  
Acetabular Cup ◽  
Total Hip

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

2020 ◽  
Vol 4 (04) ◽  
pp. 155-157
Author(s):  
Michael Newman ◽  
David Hartwright
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Pelvic Radiograph ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Stems ◽  
Hip Arthroplasties ◽  
Acetabular Components ◽  
Insight Into

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented 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 and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

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