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.

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 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.

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

AUTOMATED RANGE-OF-MOTION DEVICE FOR TOTAL HIP ARTHROPLASTY PROSTHESIS

2006 ◽  
Vol 10 (03) ◽  
pp. 151-155 ◽  
Author(s):  
Prashanth P. Prabhakar ◽  
Qingshan Chen ◽  
Fredrick Schultz ◽  
Jean Yves Lazennec ◽  
Kai-Nan An
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
External Rotation ◽  
Three Dimensional ◽  
Coordinate Measuring Machine ◽  
Acetabular Cup ◽  
Total Hip ◽  
Rocking Motion ◽  
Measuring Machine

Hip simulators are regularly used by researchers to assess total hip arthroplasty (THA) implants, range of motion, stability, and alignment of acetabular cup and stem. Previous papers have described three types of simulators: three-dimensional protractors, biaxial rocking motion (BRM) protractors, and single-axis prosthetic range-of-motion (PROM) devices. We have developed a new hip simulator in which the ROM device is completely automated in three independent axes (elevation, internal/external rotation, and plane of elevation). Coupled with the simulator, we used a FaroArm Gold Series coordinate measuring machine (CMM) to accurately align the implant components. The results show that the methodology and alignment setup are accurate and repeatable. With this simulator and digitizer, we are able to study the characteristics of numerous THA implants at various orientations of the pelvis, acetabular cup, stem, and femur.

Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty

2016 ◽  
Vol 40 (12) ◽  
pp. 2495-2504 ◽  
Author(s):  
Markus Weber ◽  
Michael Woerner ◽  
Benjamin Craiovan ◽  
Florian Voellner ◽  
Michael Worlicek ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Current Standard ◽  
Total Hip ◽  
Combined Anteversion ◽  
Prosthetic Impingement

scholarly journals Patient-Specific Safe Zone Based on Daily Positions and Range of Motion

10.29007/nw28 ◽  
2020 ◽  
Author(s):  
Wistan Marchadour ◽  
Guillaume Dardenne ◽  
Aziliz Guezou-Philippe ◽  
Christian Lefèvre ◽  
Eric Stindel
Keyword(s):  
Total Hip Arthroplasty ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Pelvic Tilt ◽  
Safe Zone ◽  
Patient Specific ◽  
Total Hip ◽  
Prosthetic Impingement ◽  
Param Eters

Cup orientation is a challenging step in total hip arthroplasty (THA), to ensure comfort of the patient and durability of the prosthesis. The safe zone defined by Lewinnek is commonly used for cup orientation, but it is nowadays being questioned because it is not patient-specific.We propose to define a new safe zone for cup orientation, that considers patient-specific parameters such as the pelvic tilt and the range of motion (ROM) of the leg.We developed a software that easily computes a unique safe zone from these param- eters in different daily positions, ensuring a cup orientation without risks of prosthetic impingement.

scholarly journals Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

2020 ◽  
Vol 10 (8) ◽  
pp. 2695
Author(s):  
Claudio Belvedere ◽  
Giada Lullini ◽  
Maurizio Ortolani ◽  
Andrea Ensini ◽  
Stefano Durante ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Range Of Motion ◽  
Hip Arthroplasty ◽  
Three Dimensional ◽  
Motor Tasks ◽  
Large Femoral Head ◽  
Total Hip ◽  
Limited Range Of Motion

After a total hip arthroplasty, a limited range of motion and lower-limb disability continue to be observed, with these being mainly associated with the implant design and the head-to-neck ratio. Larger diameters of the head bearings were assumed to provide better stability, a larger range of motion, and smaller risks of dislocation and stem-to-liner impingement. However, these claims have never been demonstrated in real patients. The specific aim of this study was to assess, via multi-instrumental analysis, whether the range of motion of a replaced hip is limited by the stem-to-liner contact in patients with large femoral head diameters. Twenty-three patients with a total hip arthroplasty were evaluated at their one-year follow-ups using clinical and instrumental examinations. A combined three-dimensional gait analysis of the full body and videofluoroscopy analysis of the replaced hip were performed during the execution of standard, i.e., daily living, and more demanding motor tasks. The latter were meant to reach the extreme range of motion at the replaced hip site, thus revealing possible stem-to-liner contact. An original technique based on imaging and computer-aided design (CAD) models of the prosthesis components was developed to calculate the stem-to-liner distance. Excellent clinical scores were observed in the study. The gait analysis showed that the range of motion of the replaced hip in the sagittal plane, averaged over all patients, ranged from 28° to 78° in standard activities. In more demanding tasks, single peaks were as high as 110°, 39°, and 60° in the sagittal, frontal, and transverse anatomical planes, respectively. In all motor tasks, the stem-to-liner distances ranged from 8.7 to 13.0 mm on average, with one outlier minimum distance being 2.2 mm. This study shows that, even in demanding motor tasks and with an extreme range of motion, the hip joint replaced with large femoral head diameters did not experience impingement between the prosthesis components.

scholarly journals A Preoperative Analytical Model for Patient-Specific Impingement Analysis in Total Hip Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Yolanda Gu ◽  
Jim Pierrepont ◽  
Catherine Stambouzou ◽  
Qing Li ◽  
Jonathan Baré
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Computational Simulation ◽  
Target Range ◽  
Patient Specific ◽  
Component Alignment ◽  
Total Hip ◽  
Risk Zones ◽  
The Impact ◽  
Prosthetic Impingement

Prosthetic impingement is important to consider during total hip arthroplasty planning to minimise the risk of joint instability. Modelling impingement preoperatively can assist in defining the required component alignment for each individual. We developed an analytical impingement model utilising a combination of mathematical calculations and an automated computational simulation to determine the risk of prosthetic impingement. The model assesses cup inclination and anteversion angles that are associated with prosthetic impingement using patient-specific inputs, such as stem anteversion, planned implant types, and target Range of Motion (ROM). The analysed results are presented as a range of cup inclination and anteversion angles over which a colour map indicates an impingement-free safe zone in green and impingement risk zones in red. A validation of the model demonstrates accuracy within +/- 1.4° of cup inclination and anteversion. The study further investigated the impact of changes in stem anteversion, femoral head size, and head offset on prosthetic impingement, as an example of the application of the model.

Posterior lesser trochanter line should not be used as reference for assessing femoral version in CT scans: a retrospective reliability and agreement study

2016 ◽  
Vol 58 (9) ◽  
pp. 1101-1107
Author(s):  
Michael Worlicek ◽  
Markus Weber ◽  
Benjamin Craiovan ◽  
Florian Zeman ◽  
Joachim Grifka ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Femoral Condyle ◽  
Three Dimensional ◽  
Ct Scans ◽  
Lesser Trochanter ◽  
Total Hip ◽  
Femoral Version ◽  
Posterior Femoral Condyle ◽  
Significant Difference

Background The estimation of femoral version in preoperative planning of total hip arthroplasty and to assess complications after total hip arthroplasty is crucial. Recent studies have recommended the posterior lesser trochanter line as an intraoperative reference for estimating femoral version. We hypothesized, that if there is a correlation, the posterior lesser trochanter line could be used to assess femoral version in computed tomography (CT) scans. Purpose To evaluate the correlation between the posterior lesser trochanter line and the posterior femoral condyle axis. Material and Methods CT scans of 126 patients after unilateral total hip arthroplasty were analyzed by means of a newly developed digital planning software for CT scans. Both hips were measured, the angle between the posterior lesser trochanter line and the posterior femoral condyle axis was determined, and the relationship between both lines was evaluated. Results We found significant differences between male and female patients ( P < 0.001) and between left and right femora ( P = 0.001). There was no significant difference between healthy hips and hips with osteoarthritis after total hip arthroplasty ( P = 0.901). Conclusion There is no reliable correlation between posterior lesser trochanter line and posterior femoral condyle axis. Therefore, posterior lesser trochanter line should not be used to assess femoral version in CT scans. As a consequence, the gold standard for measuring femoral version should still be a three-dimensional CT scan of the whole femur.

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