Restoration of the Hip Center During THA Performed for Protrusio Acetabuli Is Associated With Better Implant Survival

Baghdadi, Yaser M. K.; Larson, A. Noelle; Sierra, Rafael J.

doi:10.1007/s11999-013-3072-x

Cited by 59 publications

(64 citation statements)

References 19 publications

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“…32 If the COR does influence these factors, it is mostly because of displacement in the LM plane. 29,30,33 This suggests that in our study only one outlier of 5 mm in the LM plane might be clinically relevant, which appears to have been confirmed as the hip dislocated.…”

Section: Discussionsupporting

confidence: 64%

“…Some studies claim that small differences of 1 mm to 2 mm increase wear, the load on the hip, and the risk of aseptic loosening and subsequent revision. [28][29][30] Other studies have found no influence of the COR on wear 31 and good outcomes in patients with a high COR. 32 If the COR does influence these factors, it is mostly because of displacement in the LM plane.…”

Section: Discussionmentioning

confidence: 95%

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The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip

Baauw

et al. 2015

The Bone & Joint Journal

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We evaluated the accuracy with which a custom-made acetabular component could be positioned at revision arthroplasty of the hip in patients with a Paprosky type 3 acetabular defect. A total of 16 patients with a Paprosky type 3 defect underwent revision surgery using a custom-made trabecular titanium implant. There were four men and 12 women with a median age of 67 years (48 to 79). The planned inclination (INCL), anteversion (AV), rotation and centre of rotation (COR) of the implant were compared with the post-operative position using CT scans. A total of seven implants were malpositioned in one or more parameters: one with respect to INCL, three with respect to AV, four with respect to rotation and five with respect to the COR. To the best of our knowledge, this is the first study in which CT data acquired for the pre-operative planning of a custom-made revision acetabular implant have been compared with CT data on the post-operative position. The results are encouraging.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 95%

The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip

Baauw

et al. 2015

The Bone & Joint Journal

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“…Finally, the center of rotation was lateralized by 6 mm. Baghdadi et al [3] used the same technique to assess the change of the center of rotation and found a mean of 11 mm.…”

Section: Discussionmentioning

confidence: 99%

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Abdel

Roth

Jennings

et al. 2016

Clinical Orthopaedics &Amp; Related Research

500

301

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Background Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40°± 10°a nd 15°± 10°, respectively, represent a ''safe zone'' as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate. Questions/purposes We sought to determine if these classic radiographic targets for cup inclination and anteversion accurately predicted a safe zone limiting dislocation in a contemporary THA practice.Methods From a cohort of 9784 primary THAs performed between 2003 and 2012 at one institution, we retrospectively identified 206 THAs (2%) that subsequently dislocated. Radiographic parameters including inclination, anteversion, center of rotation, and limb length discrepancy were analyzed. Mean followup was 27 months (range, 0-133 months). Results The majority (58% [120 of 206]) of dislocated THAs had a socket within the Lewinnek safe zone. Mean cup inclination was 44°± 8°with 84% within the safe zone for inclination. Mean anteversion was 15°± 9°with 69% within the safe zone for anteversion. Sixty-five percent of dislocated THAs that were performed through a posterior approach had an acetabular component within the combined acetabular safe zones, whereas this was true for only 33% performed through an anterolateral approach. An acetabular component performed through a posterior approach was three times as likely to be within the combined acetabular safe zones (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.1-1.6) than after an anterolateral approach (OR, 0.4; 95% CI, 0.2-0.7; p \ 0.0001). In contrast, acetabular components performed through a posterior approach (OR, 1.6; 95% CI, 1.2-1.9) had an increased risk of dislocation compared with those performed through an anterolateral approach (OR, 0.8; 95% CI, 0.7-0.

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“…Although this is a 3-dimensional templating study, there has been good correlation reported between these methods and fi nal implant position and size of implant used, whether a 2-dimensional or 3-dimensional digital templating method is used. [22][23][24][25][26][27][28][29] With the increasing number of bonepreserving THAs being performed globally, an implant system that optimizes the normal femoral anatomy is benefi cial. This study shows that if the recommended femoral resection level of 5-mm proximal to the shoulder region of the femoral neck is used, the available implant neck angles using a femoral neck-retaining stem are more likely to recreate the 3-dimensional anatomy of the proximal femur.…”

Section: Discussionmentioning

confidence: 99%

Reproducing the Hip Center With a Femoral Neck-Retaining Implant

Mihalko¹,

Assaf²,

Sungu³

2015

Orthopedics

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Because of the recent trend for total hip arthroplasty in younger patients, more bone-preserving implants have been designed, based partly on the premise that maintenance of more bone stock would allow revision with standard primary implants. Another possible advantage of an implant that retains the femoral neck is that it may allow anatomical recreation of the center of the femoral head, femoral neck anteversion, anterior tilt, and caput-collum-diaphysis (CCD) angle, as well as femoral offset and leg length, without the use of modular implants. To determine whether the proximal femoral anatomy could be recreated, this study used computed tomography data and 3-dimensional modeling from 10 cadaver hips in 6 whole body specimens. Three femoral neck resection levels were investigated: 2 mm, 5 mm (recommended resection), and 10 mm from the base of the femoral neck. Results showed that the center of the femoral head, femoral neck anteversion, and CCD angle could all be recreated with available implant sizes, without modularity, within 2° and 1 mm on average. The addition of a modular neck provided no advantage in recreation of the hip center or other anatomical parameters. Use of a short metaphyseal femoral neck retaining-type of stem should allow restoration of anatomical parameters without the use of an exchangeable modular femoral neck.

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Restoration of the Hip Center During THA Performed for Protrusio Acetabuli Is Associated With Better Implant Survival

Abstract: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 59 publications

References 19 publications

The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip

The accuracy of positioning of a custom-made implant within a large acetabular defect at revision arthroplasty of the hip

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Reproducing the Hip Center With a Femoral Neck-Retaining Implant

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