The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty

Widmer, Karl-Heinz; Majewski, M.

doi:10.1016/j.clinbiomech.2005.04.003

Cited by 71 publications

(44 citation statements)

References 22 publications

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“…Hips with a fulcrum need less impact and may dislocate without a fracture, even more so when the posterior border is less prominent. As shown in the literature for prosthetic posterior hip dislocations, low femoral antetorsion or even retrotorsion [8] and an increased centrum-collum-diaphyseal (CCD) angle [28] have the same effect in decreasing the clearance for internal rotation in flexion. This is consistent with the literature for dislocation of native hips with femoral retroversion [27].…”

Section: Discussionmentioning

confidence: 92%

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Steppacher

Albers

Siebenrock

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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Background Traumatic posterior hip dislocation in adults is generally understood to be the result of a high-energy trauma. Aside from reduced femoral antetorsion, morphologic risk factors for dislocation are unknown. We previously noticed that some hips with traumatic posterior dislocations had evidence of morphologic features of femoroacetabular impingement (FAI), therefore, we sought to evaluate that possibility more formally. Questions/purposes We asked whether hips with a traumatic posterior hip dislocation present with (1) a cam-type deformity and/or (2) a retroverted acetabulum. Methods We retrospectively compared the morphologic features of 53 consecutive hips (53 patients) after traumatic posterior hip dislocation with 85 normal hips (44 patients) based on AP pelvic and crosstable axial radiographs. We measured the axial and the lateral alpha angle for detection of a cam deformity and the crossover sign, ischial spine sign, posterior wall sign, retroversion index, and ratio of anterior to posterior acetabular coverage to describe the acetabular orientation. Results Hips with traumatic posterior traumatic dislocation were more likely to have cam deformities than were normal hips, in that the hips with dislocation had increased axial and lateral alpha angles. Hips with posterior dislocation also were more likely to be retroverted; dislocated hips had a higher prevalence of a positive crossover sign, ischial spine sign, and posterior wall sign, and they had a higher retroversion index and increased ratio of anterior to posterior acetabular coverage. Conclusions Hips with posterior traumatic dislocation typically present with morphologic features of anterior FAI, including a cam-type deformity and retroverted acetabulum.

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Section: Discussionmentioning

confidence: 92%

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Steppacher

Albers

Siebenrock

et al. 2013

Clinical Orthopaedics &Amp; Related Research

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“…Including variation of femoral anatomy in the model would allow for greater variation in femoral anteversion. ROM results were also limited to primary motions, which enabled easier comparison to earlier studies [16,31,32]. It would be interesting and relevant to expand the contact detection algorithm to consider composite motions typical of common activities at risk for dislocation [23].…”

Section: Discussionmentioning

confidence: 99%

“…Mathematical modeling has been used previously [31,32] to compute the optimal combination of implant alignment parameters for maximum hip ROM, but patient-specific factors, such as potential bony impingement, were not considered. One recent study did consider the effect of bony impingement on hip ROM for varying orientations of cup abduction, cup anteversion, and femoral anteversion [16], and bony impingement reportedly preceded component impingement in 44% of the cases considered.…”

Section: Introductionmentioning

confidence: 99%

Computer-assisted versus Manual Alignment in THA: A Probabilistic Approach to Range of Motion

Petrella

Stowe

D’Lima

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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Dislocation remains a major complication after THA, and range of motion before impingement is important in joint stability. Variability in implant alignment affects resultant range of motion. We used a probabilistic modeling approach to assess the effects of implant alignment variability based on manual and computer-assisted surgical (CAS) techniques on resultant range of motion after THA. We implemented a contact detection algorithm within a probabilistic analysis framework. The normally distributed alignment variables (mean ± 1 standard deviation) were cup abduction (manual = 45°± 7.6°, CAS = 45°± 5.7°), cup anteversion (manual = 20°± 9.6°, CAS = 20°± 4.5°), and stem anteversion (manual and CAS = 10°± 1.5°). The outcomes of the probabilistic analysis were range of motion distributions with 1% and 99% bounds. The upper bounds of motion for manual and CAS alignment were similar because bony impingement was the limiting factor. The lower bounds of range of motion were substantially different depending on the type of surgical alignment; manual alignment produced a smaller range of motion in 3% to 5% of cases. CAS implant alignment produced range of motion values above minimum acceptable levels in all cases simulated.

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“…Whilst abduction is generally a safe position unless in extreme range (as in performing a split) and therefore not of concern in the vast majority of hip replacement patients the value of increasing inferior jump distance may be in mixed abduction and flexion activities (riding a horse or a jetski) as demonstrated above. Further, the model does not take into account the soft tissue envelope that will, in-vivo, have a significant influence on range (allowance and restriction) and potential impingement [32].…”

Section: Discussionmentioning

confidence: 99%

Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study

et al. 2018

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Background: The use of elevated lip polyethylene liners with the acetabular component is relatively common in Total Hip Arthroplasty (THA). Elevated lip liners increase stability of the THA by increasing the jump distance in one direction. However, the elevated lip, conversely, also reduces the primary arc in the opposite direction and leads to early impingement of the neck on the elevated lip, potentially causing instability.The aim of the present study is to determine the total range of motion of the femoral head component within the acetabular component with the elevated lip liner in different orientations within the acetabular cup.Methods: We introduce a novel experimental (ex-vivo) framework for studying the effects lip liner orientation on the range of motion of the femoral component. For constant acetabular cup orientation, the elevated lip liner was positioned superiorly and inferiorly. The femoral component range of motion in the coronal, sagittal and axial plane was measured. To avoid any confounding influences of out of plane motion, the femoral component was constrained to move in the tested plane.Results: This experimental set up introduces a rigorous framework in which to test the effects of elevated lip liner orientations on the range of motion of the femoral head component in abduction, adduction, flexion, extension and rotation. The movements of this experimental set-up are directly informative of patient's maximum potential postoperative range of motion. Initial results show that an in-

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The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty

Cited by 71 publications

References 22 publications

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Femoroacetabular Impingement Predisposes to Traumatic Posterior Hip Dislocation

Computer-assisted versus Manual Alignment in THA: A Probabilistic Approach to Range of Motion

Elevated Lip Liner Positions Improving Stability in Total Hip Arthroplasty – An Experimental Study

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