What is the tolerated width of periacetabular osteophytes to avoid impingement in cementless THA?: a three-dimensional simulation study
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Impingement is a risk factor for instability and prosthetic failure following total hip arthroplasty (THA). If the periacetabular osteophytes are not removed at surgery, impingement could occur between the osteophytes and the femoral stem following THA. However, excessive removal of the osteophytes could lead to bleeding from the bone. The aim of our study, therefore, was to locate the site of the impingement and to determine the width of tolerable osteophytes, which does not induce impingement during activities of daily living (ADL), using a three-dimensional simulation.
On 35 hip models, virtual THA was performed. The acetabular cups were positioned at 45° abduction and 20° anteversion, and the anteversion of femoral stems was 15°. Circular osteophytes with a 30-mm rim were built around the acetabular cup. Fourteen ADL motions were simulated, and the osteophytes were removed until there was no impingement. A clock face was used to map the location and the width of tolerable osteophytes.
The impingement mainly occurred in antero-superior and posterior portions around the acetabular cup. Only 4.2–6.2-mm osteophytes were tolerable at the antero-superior portion (12–3 o’clock) and 6.3–7.2-mm osteophytes at the posterior portion (8–10 o’clock) following a total hip arthroplasty. In antero-inferior and postero-superior portions, over-20-mm osteophytes did not induce any impingement.
Osteophytes in the antero-superior and posterior portion of the acetabulum should be excised during a THA to avoid impingement of the femur–stem construct on the acetabular osteophytes during ADLs.
KeywordsHip Arthroplasty Osteophyte Impingement Simulation
We specially thank Taehyun Nam, staff, Department of Radiology, Seoul National University Bundang Hospital for advising of 3-D model segmentation and Tae Jin Shin, Director, Corentec for providing 3-D models of the THA implants.
There is no funding source.
Compliance with ethical standards
Conflict of interest
One of the authors was an Educational Consultant of Stryker & Smith and Nephew and got a grant from Bone Therapeutics.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 2.Renkawitz T, Weber M, Springorum H, 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 Jt J 97(7):890–898CrossRefGoogle Scholar
- 7.Zhang W, Moskowitz RW, Nuki G, Abramson S, Altman RD, Arden N, Bierma-Zeinstra S, Brandt KD, Croft P, Doherty M, Dougados M, Hochberg M, Hunter DJ, Kwoh K, Lohmander LS, Tugwell P (2008) OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthr Cartil 16(2):137–162. https://doi.org/10.1016/j.joca.2007.12.013 CrossRefPubMedGoogle Scholar
- 12.Rodriguez-Elizalde S, Yeager AM, Ravi B, Lipman JD, Salvati EA, Westrich GH (2013) Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty. HSS J 9(3):223–228. https://doi.org/10.1007/s11420-013-9337-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Tsurumoto T, Saiki K, Okamoto K, Imamura T, Maeda J, Manabe Y, Wakebe T (2013) Periarticular osteophytes as an appendicular joint stress marker (JSM): analysis in a contemporary Japanese skeletal collection. PLoS One 8(2):e57049. https://doi.org/10.1371/journal.pone.0057049 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Lecerf G, Fessy MH, Philippot R, Massin P, Giraud F, Flecher X, Girard J, Mertl P, Marchetti E, Stindel E (2009) Femoral offset: anatomical concept, definition, assessment, implications for preoperative templating and hip arthroplasty. Orthop Traumatol Surg Res: OTSR 95 (3):210–219. https://doi.org/10.1016/j.otsr.2009.03.010 CrossRefPubMedGoogle Scholar
- 21.No author listed (2016) Openmesh, data structure for mesh. http://www.openmesh.org. Accessed 30 June 2016
- 22.Patel AB, Wagle RR, Usrey MM, Thompson MT, Incavo SJ, Noble PC (2010) Guidelines for implant placement to minimize impingement during activities of daily living after total hip arthroplasty. J Arthroplasty 25(8):1275–1281 e1271. https://doi.org/10.1016/j.arth.2009.10.007 CrossRefPubMedGoogle Scholar
- 25.Meermans G, Doorn JV, Kats JJ (2016) Restoration of the centre of rotation in primary total hip arthroplasty: the influence of acetabular floor depth and reaming technique. Bone Jt J 98-B (12):1597–1603. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0345.R1 CrossRefGoogle Scholar
- 27.No author listed (2016) Qt, Cross-platform software development. https://www.qt.io. Accessed 30 June 2016
- 28.No author listed (2015) libQGLViewer, OpenGL 3D viewers for Qt. http://libqglviewer.com. Accessed 30 June 2016
- 32.Wu G, Siegler S, Allard P, Kirtley C, Leardini A, Rosenbaum D, Whittle M, D’Lima DD, Cristofolini L, Witte H, Schmid O, Stokes I, Standardization, Terminology Committee of the International Society of B (2002) ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion–part I: ankle, hip, and spine. Int Soc Biomech J Biomech 35(4):543–548CrossRefGoogle Scholar
- 33.Fernquest S, Arnold C, Palmer A, Broomfield J, Denton J, Taylor A, Glyn-Jones S (2017) Osseous impingement occurs early in flexion in cam-type femoroacetabular impingement: a 4D CT model. Bone Jt J 99-B (4 Supple B):41–48. https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1274.R1 CrossRefGoogle Scholar
- 35.Pierrepont J, Hawdon G, Miles BP, Connor BO, Bare J, Walter LR, Marel E, Solomon M, McMahon S, Shimmin AJ (2017) Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Jt J 99-B(2):184–191. https://doi.org/10.1302/0301-620X.99B2.BJJ-2016-0098.R1 CrossRefGoogle Scholar
- 36.Chandler DR, Glousman R, Hull D, McGuire PJ, Kim IS, Clarke IC, Sarmiento A (1982) Prosthetic hip range of motion and impingement. The effects of head and neck geometry. Clin Orthop Relat Res 166:284–291Google Scholar