Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty

Widmer, Karl-Heinz

doi:10.1007/s00264-007-0429-3

Cited by 83 publications

(77 citation statements)

References 15 publications

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“…When considering the concept of cup ''safe'' zones [48,79], implant positioning was certainly suboptimal in our cases [41]. Thus, our assumption that such wear patterns were indeed ''normal'' may be incorrect.…”

Section: Discussionmentioning

confidence: 92%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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Background Concerns have been raised about the sequelae of metal-on-metal (MoM) bearings in total hip arthroplasty (THA). However, retrieval studies, which offer the best insight into the clinically relevant mechanisms of MoM wear, have followed predictable trends to date such as indicting cobalt-chromium (CoCr) metallurgy, cup design, high conformity between the head and cup, ''steep cups,'' ''microseparation,'' and ''edge wear.'' Questions/purposes We wished to evaluate a set of retrieved 28-mm MoM THA for signs of (1) cup-to-stem impingement; (2) normal wear pattern and concomitant stripe damage on femoral heads that would signify adverse wear mechanics; and (3) well-defined evidence of thirdbody scratches on bearings that would indicate large abrasive particles had circulated the joint space. Methods Ten 28-mm MOM retrievals were selected on the basis that femoral stems were included. Revision surgeries at 3 to 8 years were for pain, osteolysis, and cup loosening. CoCr stems and the MoM bearings were produced by one vendor and Ti6Al4V stems by a second vendor. All but two cases had been fixed with bone cement. We looked for patterns of normal wear and impingement signs on femoral necks and cup rims. We looked for adverse wear defined as stripe damage that was visually apparent on each bearing. Wear patterns were examined microscopically to determine the nature of abrasions and signs of metal transfer. Graphical models recreated femoral neck and cup designs to precisely correlate impingement sites on femoral necks to cup positions and head stripe patterns.

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Section: Discussionmentioning

confidence: 92%

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Clarke

Lazennec

Savisaar

et al. 2013

Clin Orthop Relat Res

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“…However, the anatomic features of the acetabulum are not reflected, so cup containment (bone coverage) might not be achieved using this approach. 4 Yet other studies support cup implantation closely matching the individual's original acetabular anatomy. 7,9 With such an anatomic reconstruction technique, the cup is implanted according to the original position, for which the TAL is a good anatomic landmark.…”

Section: Discussionmentioning

confidence: 99%

“…4 Bone impingement between the anterior acetabulum and femur may occur in excessive bone coverage, whereas insufficient bone coverage leads to psoas-impingement at the anterior rim of the cup. 4 Reconstruction of the original individual anatomy of the hip joint may provide desirable postoperative outcomes in THA.…”

Section: Discussionmentioning

confidence: 99%

Using the Transverse Acetabular Ligament as a Landmark for Acetabular Anteversion: An Intraoperative Measurement

Inoue

Majima

Abe

et al. 2013

J Orthop Surg (Hong Kong)

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purpose. To measure the transverse acetabular ligament (TAL) anteversion in hips with severe deformity, using fluoroscopy-computed tomographic navigation. Methods. 31 hips in 10 men and 19 women aged 40 to 78 (mean, 58.7) years who underwent total hip arthroplasty for primary osteoarthritis (n=6) or osteoarthritis secondary to developmental hip dysplasia (n=19) or congenital hip dislocation (n=6) were included. The severity of hip dislocation was classified according to the Crowe classification; 15 hips were grade 1, 7 were grade 2, 3 were grade 3, and 6 were grade 4. The TAL anteversion was measured using fluoroscopy-computed tomographic navigation. The difference in TAL anteversion between non-dislocated hips (Crowe grade 1, n=15) and dislocated hips (Crowe grades 2-4, n=16) was compared. results. In all 31 hips, the TAL could be visualised intra-operatively. No patient reported severe pain, Using the transverse acetabular ligament as a landmark for acetabular anteversion: an intraoperative measurement early wear, loosening, or dislocation after 2 years. The mean TAL anteversion and inclination angles measured by the navigation system were 26.5º (SD, 8.9º; range, and 41.5º (SD, 4.6º; range, 32º-49º), respectively. 22 of the 31 hips were in the safe zone. TAL anteversion in non-dislocated and dislocated hips was not significantly different. Interand intra-observer mean absolute differences in TAL anteversion were 0.3º and 0.4º, respectively. conclusion. The TAL is a useful anatomic landmark for total hip arthroplasty in dislocated hips.

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“…The ROM of THA is known to be determined by two major factors: implant design variables (head/neck ratio, cup design, and oscillation angle) and the surgical orientation of the prosthetic components (cup inclination, cup anteversion, angle of femoral neck component from the horizontal plane, and femoral neck anteversion) [9]. Use of a larger femoral head provides an increase in the oscillation ROM range of motion, ADL activities of daily living, Flex flexion, Abd abduction, ER external rotation, Inc inclination, Ant anteversion, P values for parameters were determined using the Mann-Whitney test angle.…”

Section: Discussionmentioning

confidence: 99%

Activities of daily living after total hip arthroplasty. Is a 32-mm femoral head superior to a 26-mm head for improving daily activities?

Matsushita

Morita

Ito

et al. 2009

International Orthopaedics (SICOT)

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Range of motion (ROM) of the hip joint after total hip arthroplasty (THA) could be increased by using a larger prosthetic femoral head, but it is not known whether the activities of daily living (ADL) are influenced by THA with different head sizes. Our objective was to compare postoperative ADL in patients who underwent THA using a head diameter of 26 mm or 32 mm. We assessed the range of motion and the mode of ADL after cementless primary THA. Comparison was performed between 25 joints of 24 patients who underwent THA with a 26-mm femoral head (26-mm group) and 24 joints of 20 patients with a 32-mm head (32-mm group). The postoperative range of flexion and abduction was significantly larger in the 32-mm group than in the 26-mm group. With respect to the mode of performing selected ADL such as putting on and removing pants, socks, and cutting toenails, many patients adopted the compensatory position of lumbar flexion with hip flexion plus knee extension in the 26-mm group, while a majority of the patients from the 32-mm group employed the mode of hip flexion with knee flexion. Patients with the 32-mm head showed better postoperative ADL of the ipsilateral side compared with the 26-mm head.

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Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty

Cited by 83 publications

References 15 publications

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Risk of Impingement and Third-body Abrasion With 28-mm Metal-on-metal Bearings

Using the Transverse Acetabular Ligament as a Landmark for Acetabular Anteversion: An Intraoperative Measurement

Activities of daily living after total hip arthroplasty. Is a 32-mm femoral head superior to a 26-mm head for improving daily activities?

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