Range of Movement for Impingement and Dislocation Avoidance in Total Hip Replacement Predicted by Finite Element Model

Abstract

Dislocation is a serious complication in total hip replacement (THR). An inadequate range of movement (ROM) can lead to impingement of the prosthesis neck on the acetabular cup; furthermore, the initiation of subluxation and dislocation may occur. The objective of this study was to generate a parametric three-dimensional finite element (FE) model capable of predicting the dislocation stability for various positions of the prosthetic head, neck, and cup under various activities. Three femoral head sizes (28, 32, and 36 mm) were simulated. Nine acetabular placement positions (abduction angles of 25°, 40° and 60° combined with anteversion angles of 0°, 15° and 25°) were analyzed. The ROM and maximum resisting moment (RM) until dislocation were evaluated based on the stress distribution in the acetabulum component. The analysis allowed for the definition of a “safe zone” of movement for impingement and dislocation avoidance in THR: an abduction angle of 40°–60° and anteversion angle of 15°–25°. It is especially critical that the anteversion angle does not fall to 10°–15°. The sequence of the RM is a valid parameter for describing dislocation stability in FE studies.

An increase in the risk of excessive femoral anteversion for relatively younger age and types of femoral morphology in total hip arthroplasty with direct anterior approach

“…6 On the other hand, the “safe zone” for the movement avoiding the impingement and dislocation in THA predicted by the proposed parametric 3-D finite element model is 15–25° anteversion and 40–60° abduction. 12…”

“…6 On the other hand, the "safe zone" for the movement avoiding the impingement and dislocation in THA predicted by the proposed parametric 3-D finite element model is 15-25 anteversion and 40-60 abduction. 12 There is purported improvement in component positioning and hip stability with the use of DAA-THA. Although fluoroscopic assistance seems to decrease complications such as femoral fracture by varus or flexed implantation of the stem, surgeons changing from PLA to DAA for THA should consider potential excessive cup anteversion and varus or flexed implantation of the stem in their early experience with DAA.…”

Personalized Cup Positioning Guides Improved Cup Positioning and Hip Ranges of Motion in Robotic Assisted Total Hip Arthroplasty

“…Conclusively, impingement and dislocation are associated with parts of excessive small parameters of HROMs that are determined by inclination and anteversion of cups. The ways to study HROMs include cadaver study, CT three-dimension reconstruction, and skeletal muscle model ( Martin et al, 2008 ; Mccarthy et al, 2016 , 2017 ; Ezquerra et al, 2017 ; Goh et al, 2017 ; Jamari et al, 2017 ; Ohmori et al, 2017 ; Sonntag et al, 2017 ). Using cadaveric hip, Martin ( Martin et al, 2008 ) demonstrated not only the impingement between bones or prostheses but also the limitations among ligaments, muscle, and capsule, which reflected the real situation of dislocation.…”

Cup-To-Neck Contact and Range of Motion after Total Hip Arthroplasty with Large Head Diameters: An Original Three-Dimensional Combined Gait and Videofluoroscopy Analysis

“…Due to the known technical limitations of these techniques, the ROM at the replaced hip joint is an approximated estimation and the exact cup-to-neck interaction cannot be determined with these instruments. In vitro [24,25] and in silico [26][27][28][29] evaluations have thus been performed as well, but these suffer from unrealistic soft tissue arrangements and overall motion and loading conditions. Today, very little is known about the ROM at the replaced hip in large and extreme joint movements.…”