The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

Widmer, Karl-Heinz

doi:10.1097/corr.0000000000001233

Cited by 59 publications

(72 citation statements)

References 101 publications

(132 reference statements)

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“…Regarding the influence of THR design parameters, we observed a minor influence of the CCD angle on ROM for all movements, which is in accordance to the study by Widmer et al [51]. It is also known that a change in CCD angles requires adaption of cup anteversion, to overcome the reduction of ROM caused by increased CCD angle [41], which we also observed during flexion movement. However, inaccuracy of the manually performed alignment of the femoral hip stem is a factor that influences the ROM as a function of the CCD angle.…”

Section: Discussionsupporting

confidence: 91%

“…Previous studies described the effect of the orientation of the acetabular cup, prosthetic head size on the impingement, and risk of dislocation [21,39,40]. A recent computational study conducted by Widmer et al [41] optimized the recommendations to reach the largest impingement-free ROM, by finding optimal target zones for implant positioning; this was achieved by using 3D kinematic hip motion analyses with respect to the contribution of various intraoperative positioning and implant design parameters. In a retrospective study, the sagittal orientation of the pelvis after THR was investigated, which is an important factor for functional cup orientation [42].…”

Section: Introductionmentioning

confidence: 99%

“…However, most of the studies did not consider real patient-specific data or were mostly based on computed tomography (CT) scans, which were hazardous for the patient, and, therefore, not the first choice in a preoperative planning scenario. The ROM is linked to the postoperative outcome and has attracted attention from the research community by using experimental and numerical methods [21,30,38,41,[43][44][45][46][47][48][49][50][51][52]. Despite these studies, there is, to our knowledge, no approach that can be used to assess ROM in preoperative planning without subjecting the patient to additional radiation by CT scanning.…”

Section: Introductionmentioning

confidence: 99%

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An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

et al. 2021

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The calculation of range of motion (ROM) is a key factor during preoperative planning of total hip replacements (THR), to reduce the risk of impingement and dislocation of the artificial hip joint. To support the preoperative assessment of THR, a magnetic resonance imaging (MRI)-based computational framework was generated; this enabled the estimation of patient-specific ROM and type of impingement (bone-to-bone, implant-to-bone, and implant-to-implant) postoperatively, using a three-dimensional computer-aided design (CAD) to visualize typical clinical joint movements. Hence, patient-specific CAD models from 19 patients were generated from MRI scans and a conventional total hip system (Bicontact® hip stem and Plasmacup® SC acetabular cup with a ceramic-on-ceramic bearing) was implanted virtually. As a verification of the framework, the ROM was compared between preoperatively planned and the postoperatively reconstructed situations; this was derived based on postoperative radiographs (n = 6 patients) during different clinically relevant movements. The data analysis revealed there was no significant difference between preoperatively planned and postoperatively reconstructed ROM (∆ROM) of maximum flexion (∆ROM = 0°, p = 0.854) and internal rotation (∆ROM = 1.8°, p = 0.917). Contrarily, minor differences were observed for the ROM during maximum external rotation (∆ROM = 9°, p = 0.046). Impingement, of all three types, was in good agreement with the preoperatively planned and postoperatively reconstructed scenarios during all movements. The calculated ROM reached physiological levels during flexion and internal rotation movement; however, it exceeded physiological levels during external rotation. Patients, where implant-to-implant impingement was detected, reached higher ROMs than patients with bone-to-bone impingement. The proposed framework provides the capability to predict postoperative ROM of THRs.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

et al. 2021

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“…The concept of combined anteversion as the sum of the anatomical acetabular and femoral neck anteversion was originally proposed by McKibbin and known as the "instability index" [1]. The importance of combined anteversion in the prevention of total hip arthroplasty (THA) dislocation has been previously demonstrated [2][3][4][5][6][7][8][9]. The methodology for defining combined anteversion is different in these studies, e.g., intraoperative assessment, radiographic analysis, and mathematical models with computer simulation.…”

Section: Introductionmentioning

confidence: 99%

“…The model used six position/motions, including hip flexion positions, such as sitting, squatting, and bending forward. This resulted in 118,203 combinations, which provided a very large sample size that allowed us to make generalizable predictions.Investigators have shown the importance of combined anteversion in hip motion and in the prevention of THA dislocation[2][3][4]6,[19][20][21][22]. The common understanding of the orthopedic community is that either the stem or cup position can be changed to maintain combined anteversion.…”

mentioning

confidence: 99%

Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?

Pour

Schwarzkopf

Patel

et al. 2021

The Journal of Arthroplasty

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty

Fischer

Tokunaga

Okamoto

et al. 2022

Journal Orthopaedic Research

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The functional parameters pelvic tilt (PT) and hip joint force (HJF) are required to calculate patient‐specific target zones based on the range of motion (ROM) and implant loading for preoperative planning of total hip arthroplasty (THA). Both functional parameters may change after THA. The preoperative prediction of the postoperative PT and HJF is associated with a specific amount of uncertainty. The prediction uncertainty has to be considered in the preoperative planning process to avoid a suboptimal implantation. So far, very little attention has been paid to the necessary reduction of patient‐specific target zones by the prediction uncertainties of postoperative functional parameters. Prediction models for the postoperative PT in standing position and for the HJF during one‐leg stance as a surrogate for the peak force phase during level walking were used to quantify the reduction of the ROM‐ and load‐based target zones of 196 Japanese THA patients. The prediction uncertainty was about 14° for the postoperative standing PT and ranged from 17% body weight to 37% body weight for the components of the HJF. On average, the prosthetic ROM‐based target zone had to be significantly reduced by 43% and the load‐based target zone by 39%. This led to a median reduction of the combined prosthetic ROM‐ and load‐based target zone of 96%. The study sharpens the awareness for the substantial reduction of ROM‐ and load‐based target zones by prediction uncertainties of the postoperative PT and HJF and highlights the importance of further research to improve prediction models for both functional parameters.

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The Impingement-free, Prosthesis-specific, and Anatomy-adjusted Combined Target Zone for Component Positioning in THA Depends on Design and Implantation Parameters of both Components

Cited by 59 publications

References 101 publications

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

An MRI-Based Patient-Specific Computational Framework for the Calculation of Range of Motion of Total Hip Replacements

Is Combined Anteversion Equally Affected by Acetabular Cup and Femoral Stem Anteversion?

Implications of the uncertainty of postoperative functional parameters for the preoperative planning of total hip arthroplasty

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