Michael Woerner1, Markus Weber2, Ernst Sendtner2, Robert Springorum2, Michael Worlicek2, Benjamin Craiovan2, Joachim Grifka2, Tobias Renkawitz2. 1. Department of Orthopaedic Surgery, Regensburg University Medical Center, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany. m.woerner@asklepios.com. 2. Department of Orthopaedic Surgery, Regensburg University Medical Center, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany.
Abstract
PURPOSE: Impingement is a major source for decreased range of motion (ROM) and dislocation in total hip arthroplasty (THA). In the current study we analyzed the impact of soft tissue impingement on ROM compared to bony and/or prosthetic impingement. METHODS: In the course of a prospective clinical trial 54 patients underwent cementless total hip arthroplasty in the lateral decubitus position using imageless navigation. The navigation device enabled intra-operative ROM measurements indicating soft tissue impingement. Post-operatively, all patients received postoperative 3D-CT. Absolute ROM without bony and/or prosthetic impingement was calculated with the help of a collision-detection-algorithm. RESULTS: Due to soft tissue impingement we found a reduced ROM of over 20° (p < 0.001) compared to bony and/or prosthetic impingement regarding flexion, extension, abduction and adduction and of over 10° regarding external rotation (p < 0.001). In contrast, soft tissue impingement showed less impact on internal rotation in 90° of flexion (p = 0.76). Multivariate analysis showed an association between BMI and flexion, whereas all other ROM directions were independent of BMI. CONCLUSIONS: Soft tissue has a major impact on impingement-free ROM after THA. For the majority of movements, soft tissue restrictions are more important than bony and prosthetic impingement. Future models of patient individual joint replacement including pre-operative (CT) planning and intra-operative navigation should include algorithms additionally accounting for soft tissue impingement.
PURPOSE: Impingement is a major source for decreased range of motion (ROM) and dislocation in total hip arthroplasty (THA). In the current study we analyzed the impact of soft tissue impingement on ROM compared to bony and/or prosthetic impingement. METHODS: In the course of a prospective clinical trial 54 patients underwent cementless total hip arthroplasty in the lateral decubitus position using imageless navigation. The navigation device enabled intra-operative ROM measurements indicating soft tissue impingement. Post-operatively, all patients received postoperative 3D-CT. Absolute ROM without bony and/or prosthetic impingement was calculated with the help of a collision-detection-algorithm. RESULTS: Due to soft tissue impingement we found a reduced ROM of over 20° (p < 0.001) compared to bony and/or prosthetic impingement regarding flexion, extension, abduction and adduction and of over 10° regarding external rotation (p < 0.001). In contrast, soft tissue impingement showed less impact on internal rotation in 90° of flexion (p = 0.76). Multivariate analysis showed an association between BMI and flexion, whereas all other ROM directions were independent of BMI. CONCLUSIONS: Soft tissue has a major impact on impingement-free ROM after THA. For the majority of movements, soft tissue restrictions are more important than bony and prosthetic impingement. Future models of patient individual joint replacement including pre-operative (CT) planning and intra-operative navigation should include algorithms additionally accounting for soft tissue impingement.
Entities:
Keywords:
Impingement; Minimally invasive; Navigation; ROM; Soft Tissue; Total hip arthroplasty
Authors: Tobias Renkawitz; Martin Haimerl; Lars Dohmen; Michael Woerner; Hans-Robert Springorum; Ernst Sendtner; Guido Heers; Markus Weber; Joachim Grifka Journal: Proc Inst Mech Eng H Date: 2012-09-27 Impact factor: 1.617
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