Hidenobu Miki1, Takayuki Kyo2, Yasuo Kuroda3, Ichiro Nakahara4, Nobuhiko Sugano5. 1. Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan. Electronic address: miki_osaka@nifty.com. 2. Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan. Electronic address: t_kyo@seichokai.or.jp. 3. Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan. Electronic address: cro_magnons5@yahoo.co.jp. 4. Department of Orthopedic Surgery, Osaka National Hospital, Osaka, Japan. Electronic address: ichiro614@nifty.com. 5. Department of Orthopedic Surgery, Medical School of Osaka University, Osaka, Japan. Electronic address: n-sugano@umin.net.
Abstract
BACKGROUND: Proper implant orientation is essential for avoiding edge-loading and prosthesis impingement in total hip arthroplasty. Although cup orientation is affected by a change in pelvic tilt after surgery, it has been unclear whether surgeons can prevent impingement and edge-loading by proper positioning by taking into account any change in pelvic alignment associated with alteration of hip range of motion. METHODS: We simulated implant orientation without edge-loading and prosthesis impingement, even with a change in pelvic tilt and associated change in hip range of motion after surgery, by collision detection using implant models created with computer-aided design. FINDINGS: If posterior pelvic tilting with a corresponding hyperextension change in hip range of motion after surgery remains within 10°, as occurs in 90% of cases, surgeons can avoid edge-loading and impingement by correctly orienting the implant, even when using a conventional prosthesis. However, if a 20° change occurs after surgery, it may be difficult to avoid those risks. INTERPRETATION: Although edge-loading and impingement can be prevented by performing appropriate surgery in most cases, even when taking into account postoperative changes in pelvic tilt, it may also be important to pay attention to spinal conditions to ensure that pelvic tilting is not extreme because of increasing kyphosis.
BACKGROUND: Proper implant orientation is essential for avoiding edge-loading and prosthesis impingement in total hip arthroplasty. Although cup orientation is affected by a change in pelvic tilt after surgery, it has been unclear whether surgeons can prevent impingement and edge-loading by proper positioning by taking into account any change in pelvic alignment associated with alteration of hip range of motion. METHODS: We simulated implant orientation without edge-loading and prosthesis impingement, even with a change in pelvic tilt and associated change in hip range of motion after surgery, by collision detection using implant models created with computer-aided design. FINDINGS: If posterior pelvic tilting with a corresponding hyperextension change in hip range of motion after surgery remains within 10°, as occurs in 90% of cases, surgeons can avoid edge-loading and impingement by correctly orienting the implant, even when using a conventional prosthesis. However, if a 20° change occurs after surgery, it may be difficult to avoid those risks. INTERPRETATION: Although edge-loading and impingement can be prevented by performing appropriate surgery in most cases, even when taking into account postoperative changes in pelvic tilt, it may also be important to pay attention to spinal conditions to ensure that pelvic tilting is not extreme because of increasing kyphosis.
Authors: Abhinav K Sharma; Zlatan Cizmic; Douglas A Dennis; Stefan W Kreuzer; Michael A Miranda; Jonathan M Vigdorchik Journal: J Orthop Date: 2021-08-21
Authors: Charles Rivière; Stefan Lazic; Louis Dagneaux; Catherine Van Der Straeten; Justin Cobb; Sarah Muirhead-Allwood Journal: EFORT Open Rev Date: 2018-02-21