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Soft tissue restricts impingement-free mobility in total hip arthroplasty

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Abstract

Purpose

Impingement is a major source for decreased range of motion (ROM) and dislocation in total hip arthroplasty (THA). In the current study we analyzed the impact of soft tissue impingement on ROM compared to bony and/or prosthetic impingement.

Methods

In the course of a prospective clinical trial 54 patients underwent cementless total hip arthroplasty in the lateral decubitus position using imageless navigation. The navigation device enabled intra-operative ROM measurements indicating soft tissue impingement. Post-operatively, all patients received postoperative 3D-CT. Absolute ROM without bony and/or prosthetic impingement was calculated with the help of a collision-detection-algorithm.

Results

Due to soft tissue impingement we found a reduced ROM of over 20° (p < 0.001) compared to bony and/or prosthetic impingement regarding flexion, extension, abduction and adduction and of over 10° regarding external rotation (p < 0.001). In contrast, soft tissue impingement showed less impact on internal rotation in 90° of flexion (p = 0.76). Multivariate analysis showed an association between BMI and flexion, whereas all other ROM directions were independent of BMI.

Conclusions

Soft tissue has a major impact on impingement-free ROM after THA. For the majority of movements, soft tissue restrictions are more important than bony and prosthetic impingement. Future models of patient individual joint replacement including pre-operative (CT) planning and intra-operative navigation should include algorithms additionally accounting for soft tissue impingement.

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Acknowledgments

The help of Ms. S. Kling, Ms. C. Jendrewski, Ms. M. Riedl, Mr. M. Schubert, Mr. A. Hapfelmeier, Mr. B. Messmer, Mr. L. Dohmen, and Dr. M. Haimerl in this project is appreciated.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Regensburg University Medical Center, Asklepios Klinikum Bad Abbach, Kaiser-Karl V.-Allee 3, 93077, Bad Abbach, Germany

    Michael Woerner, Markus Weber, Ernst Sendtner, Robert Springorum, Michael Worlicek, Benjamin Craiovan, Joachim Grifka & Tobias Renkawitz

Authors
  1. Michael Woerner
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  2. Markus Weber
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  3. Ernst Sendtner
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  4. Robert Springorum
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  5. Michael Worlicek
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  6. Benjamin Craiovan
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  7. Joachim Grifka
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  8. Tobias Renkawitz
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Corresponding author

Correspondence to Michael Woerner.

Ethics declarations

Ethical approval and informed consent

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

No author’s financial or any other conflicts of interest are related directly or indirectly to the subject of this article. Funding for this clinical trial was provided by the German Federal Ministry of Education and Research (BMBF; grant number 01EZ0915). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Woerner, M., Weber, M., Sendtner, E. et al. Soft tissue restricts impingement-free mobility in total hip arthroplasty. International Orthopaedics (SICOT) 41, 277–282 (2017). https://doi.org/10.1007/s00264-016-3216-1

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  • DOI: https://doi.org/10.1007/s00264-016-3216-1

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