Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty
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In this prospective study of 135 patients undergoing cementless total hip arthroplasty (THA) we asked whether six current definitions of combined anteversion prevent impingement and increase postoperative patient individual impingement-free range-of-motion (ROM).
Implant position was measured by an independent, external institute on 3D-CT performed six weeks post-operatively. Post-operative ROM was calculated using a CT-based algorithm detecting osseous and/or prosthetic impingement by virtual hip movement. Additionally, clinical ROM was evaluated pre-operatively and one-year post-operatively by a blinded observer.
Combined component position of cup and stem according to the definitions of Ranawat, Widmer, Dorr, Hisatome and Yoshimine inhibited prosthetic impingement in over 90 %, while combined osseous and prosthetic impingement still occurred in over 40 % of the cases. The recommendations by Jolles, Widmer, Dorr, Yoshimine and Hisatome enabled higher flexion (p ≤ 0.001) and internal rotation (p ≤ 0.006). Clinically, anteversion rules of Widmer and Yoshimine provided one-year post-operatively statistically but not clinically relevant higher internal rotation (p ≤0.034).
Standard rules of combined anteversion detect prosthetic but fail to prevent combined osseous and prosthetic impingement in THA. Future models will have to account for the patient-individual anatomic situation to ensure impingement-free ROM.
KeywordsCombined anteversion Impingement Range of motion Outcome Total hip arthroplasty
We thank Dipl-Ing. Mario Schubert for his support in calculations of biomathematical combined anteversion models.
MW and TR originated the idea for the study and led on its design. TR and JG supervised the project. TR, MW, MWOE, BC, MWOR, FV and JG participated in the design of the study. MW, TR, MWOE, BC, MWOR and HS coordinated the experiment and were responsible for data acquisition. HS performed the clinical follow up. MWOR, MWOE, BC and FV were responsible for CT data collection. MW computed implant positions according to the different definitions. MW performed the statistical testing. All authors read and corrected draft versions of the manuscript and approved the final manuscript.
The project upon which this publication is based was funded by the German Federal Ministry of Education and Research (BMBF) under Project Number 01EZ0915.
Compliance with ethical standards
Conflict of interest
All authors declare no conflict of interest.
- 5.McKibbin B (1970) Anatomical factors in the stability of the hip joint in the newborn. J Bone Joint Surg (Br) 52:148–159Google Scholar
- 12.Weber M, Weber T, Woerner M, Craiovan B, Worlicek M, Winkler S, Grifka J, Renkawitz T (2015) The impact of standard combined anteversion definitions on gait and clinical outcome within one year after total hip arthroplasty. Int Orthop 39(12):2323–33. doi: 10.1007/s00264-015-2777-8
- 14.Renkawitz T, Haimerl M, Dohmen L, Gneiting S, Wegner M, Ehret N, Buchele C, Schubert M, Lechler P, Woerner M, Sendtner E, Schuster T, Ulm K, Springorum R, Grifka J (2011) Minimally invasive computer-navigated total hip arthroplasty, following the concept of femur first and combined anteversion: design of a blinded randomized controlled trial. BMC Musculoskelet Disord 12:192. doi: 10.1186/1471-2474-12-192 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Pijls BG, Dekkers OM, Middeldorp S, Valstar ER, van der Heide HJ, Van der Linden-Van der Zwaag HM, Nelissen RG (2011) AQUILA: assessment of quality in lower limb arthroplasty. An expert Delphi consensus for total knee and total hip arthroplasty. BMC Musculoskelet Disord 12:173. doi: 10.1186/1471-2474-12-173 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Renkawitz T, Haimerl M, Dohmen L, Woerner M, Springorum HR, Sendtner E, Heers G, Weber M, Grifka J (2012) Development and evaluation of an image-free computer-assisted impingement detection technique for total hip arthroplasty. Proc Inst Mech Eng H 226:911–918. doi: 10.1177/0954411912460815 CrossRefPubMedGoogle Scholar
- 18.Renkawitz T, Weber M, Springorum HR, Sendtner E, Woerner M, Ulm K, Weber T, Grifka J (2015) Impingement-free range of movement, acetabular component cover and early clinical results comparing 'femur-first' navigation and 'conventional' minimally invasive total hip arthroplasty: a randomised controlled trial. Bone Joint J 97-B:890–898. doi: 10.1302/0301-620X.97B7.34729 CrossRefPubMedGoogle Scholar
- 21.Weber M, Lechler P, von Kunow F, Vollner F, Keshmiri A, Hapfelmeier A, Grifka J, Renkawitz T (2015) The validity of a novel radiological method for measuring femoral stem version on anteroposterior radiographs of the hip after total hip arthroplasty. Bone Joint J 97-B:306–311. doi: 10.1302/0301-620X.97B3.34618 CrossRefPubMedGoogle Scholar
- 27.Tsuda K, Haraguchi K, Koyanagi J, Takahashi S, Sugama R, Fujiwara K (2016) A forty millimetre head significantly improves range of motion compared with a twenty eight millimetre head in total hip arthroplasty using a computed tomography-based navigation system. Int Orthop. doi: 10.1007/s00264-015-3095-x PubMedGoogle Scholar
- 29.Renkawitz T, Haimerl M, Dohmen L, Gneiting S, Lechler P, Woerner M, Springorum HR, Weber M, Sussmann P, Sendtner E, Grifka J (2012) The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty. BMC Musculoskelet Disord 13:65. doi: 10.1186/1471-2474-13-65 CrossRefPubMedPubMedCentralGoogle Scholar