The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty.

BACKGROUND: Biomechanical analysis and clinical experience reveal that offset total hip stems increase soft tissue tension and reduce the risk for dislocation in total hip arthroplasty. Most of these stems have a smaller neck-shaft-angle to increase the offset. This study investigates if changing the neck-shaft-angle has an impact on how cup and stem should be positioned with regard to range of motion.
METHODS: A mathematical model of a total hip arthroplasty was developed to analyze range of motion until impingement between cup and neck. Range of motion was determined for each combination of neck-shaft-angles and additional parameters like cup inclination, cup anteversion, stem antetorsion, head/neck ratio and design of the cup opening.
RESULTS: A maximized range of motion is achieved for neck-shaft-angles between 125 degrees and 131 degrees . Reducing the neck-shaft-angle by one degree requires reducing the cup anteversion by about 2 degrees and increasing the cup inclination by 0.45 degrees . Stems with neck-shaft-angles more than 135 degrees are not recommended when the head/neck ratio is 2.3 or less.
INTERPRETATION: Stems with a reduced neck-shaft-angle for an increased offset should be coupled with cups that are inclined slightly higher and less anteverted as compared to a standard stem. Precise recommendations for optimal component positioning can only be given for a specific prosthesis system regarding all parameters.