Jung-Taek Kim1, Jusung Lee2, Young-Kyun Lee3, Yong-Chan Ha4, Ye-Yeon Won1, Kunwoo Lee2, Vikas Khanduja5, Kyung-Hoi Koo6. 1. Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center Hospital, Suwon, South Korea. 2. Human centered CAD Laboratory, School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, South Korea. 3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. 4. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea. 5. Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom. 6. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea. khkoo@snu.ac.kr.
Abstract
BACKGROUNDS: Impingement is a risk factor for instability and prosthetic failure following total hip arthroplasty (THA). If the periacetabular osteophytes are not removed at surgery, impingement could occur between the osteophytes and the femoral stem following THA. However, excessive removal of the osteophytes could lead to bleeding from the bone. The aim of our study, therefore, was to locate the site of the impingement and to determine the width of tolerable osteophytes, which does not induce impingement during activities of daily living (ADL), using a three-dimensional simulation. METHODS: On 35 hip models, virtual THA was performed. The acetabular cups were positioned at 45° abduction and 20° anteversion, and the anteversion of femoral stems was 15°. Circular osteophytes with a 30-mm rim were built around the acetabular cup. Fourteen ADL motions were simulated, and the osteophytes were removed until there was no impingement. A clock face was used to map the location and the width of tolerable osteophytes. RESULTS: The impingement mainly occurred in antero-superior and posterior portions around the acetabular cup. Only 4.2-6.2-mm osteophytes were tolerable at the antero-superior portion (12-3 o'clock) and 6.3-7.2-mm osteophytes at the posterior portion (8-10 o'clock) following a total hip arthroplasty. In antero-inferior and postero-superior portions, over-20-mm osteophytes did not induce any impingement. CONCLUSION: Osteophytes in the antero-superior and posterior portion of the acetabulum should be excised during a THA to avoid impingement of the femur-stem construct on the acetabular osteophytes during ADLs.
BACKGROUNDS: Impingement is a risk factor for instability and prosthetic failure following total hip arthroplasty (THA). If the periacetabular osteophytes are not removed at surgery, impingement could occur between the osteophytes and the femoral stem following THA. However, excessive removal of the osteophytes could lead to bleeding from the bone. The aim of our study, therefore, was to locate the site of the impingement and to determine the width of tolerable osteophytes, which does not induce impingement during activities of daily living (ADL), using a three-dimensional simulation. METHODS: On 35 hip models, virtual THA was performed. The acetabular cups were positioned at 45° abduction and 20° anteversion, and the anteversion of femoral stems was 15°. Circular osteophytes with a 30-mm rim were built around the acetabular cup. Fourteen ADL motions were simulated, and the osteophytes were removed until there was no impingement. A clock face was used to map the location and the width of tolerable osteophytes. RESULTS: The impingement mainly occurred in antero-superior and posterior portions around the acetabular cup. Only 4.2-6.2-mm osteophytes were tolerable at the antero-superior portion (12-3 o'clock) and 6.3-7.2-mm osteophytes at the posterior portion (8-10 o'clock) following a total hip arthroplasty. In antero-inferior and postero-superior portions, over-20-mm osteophytes did not induce any impingement. CONCLUSION: Osteophytes in the antero-superior and posterior portion of the acetabulum should be excised during a THA to avoid impingement of the femur-stem construct on the acetabular osteophytes during ADLs.
Authors: Anisha B Patel; Rohan R Wagle; Molly M Usrey; Matt T Thompson; Stephen J Incavo; Philip C Noble Journal: J Arthroplasty Date: 2009-12-21 Impact factor: 4.757
Authors: Sebastian Rodriguez-Elizalde; Alyssa M Yeager; Bheeshma Ravi; Joseph D Lipman; Eduardo A Salvati; Geoffrey H Westrich Journal: HSS J Date: 2013-07-26
Authors: G Lecerf; M H Fessy; R Philippot; P Massin; F Giraud; X Flecher; J Girard; P Mertl; E Marchetti; E Stindel Journal: Orthop Traumatol Surg Res Date: 2009-05-06 Impact factor: 2.256