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Archives of Orthopaedic and Trauma Surgery

, Volume 138, Issue 8, pp 1165–1172 | Cite as

What is the tolerated width of periacetabular osteophytes to avoid impingement in cementless THA?: a three-dimensional simulation study

  • Jung-Taek Kim
  • Jusung Lee
  • Young-Kyun Lee
  • Yong-Chan Ha
  • Ye-Yeon Won
  • Kunwoo Lee
  • Vikas Khanduja
  • Kyung-Hoi Koo
Hip Arthroplasty
  • 167 Downloads

Abstract

Backgrounds

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

Hip Arthroplasty Osteophyte Impingement Simulation 

Notes

Acknowledgements

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.

Funding

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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Malik A, Maheshwari A, Dorr LD (2007) Impingement with total hip replacement. J Bone Jt Surg Am 89(8):1832–1842.  https://doi.org/10.2106/JBJS.F.01313 CrossRefGoogle Scholar
  2. 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
  3. 3.
    Sheth NP, Melnic CM, Paprosky WG (2016) Evaluation and management of chronic total hip instability. Bone Jt J 98-B (1 Suppl A):44–49.  https://doi.org/10.1302/0301-620X.98B1.36516 CrossRefGoogle Scholar
  4. 4.
    Padgett DE, Warashina H (2004) The unstable total hip replacement. Clin Orthop Relat Res 420:72–79CrossRefGoogle Scholar
  5. 5.
    Brooks PJ (2013) Dislocation following total hip replacement: causes and cures. Bone Jt J 95-B (11 Suppl A):67–69.  https://doi.org/10.1302/0301-620X.95B11.32645 CrossRefGoogle Scholar
  6. 6.
    Pierchon F, Pasquier G, Cotten A, Fontaine C, Clarisse J, Duquennoy A (1994) Causes of dislocation of total hip arthroplasty. CT study of component alignment. J Bone Jt Surg Br 76(1):45–48CrossRefGoogle Scholar
  7. 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
  8. 8.
    Patel PD, Potts A, Froimson MI (2007) The dislocating hip arthroplasty: prevention and treatment. J Arthroplasty 22(4 Suppl 1):86–90.  https://doi.org/10.1016/j.arth.2006.12.111 CrossRefPubMedGoogle Scholar
  9. 9.
    Sariali E, Mouttet A, Pasquier G, Durante E, Catone Y (2009) Accuracy of reconstruction of the hip using computerised three-dimensional pre-operative planning and a cementless modular neck. J Bone Jt Surg Br 91(3):333–340.  https://doi.org/10.1302/0301-620X.91B3.21390 CrossRefGoogle Scholar
  10. 10.
    Amstutz HC, Campbell PA, Le Duff MJ (2004) Fracture of the neck of the femur after surface arthroplasty of the hip. J Bone Jt Surg Am 86-A(9):1874–1877CrossRefGoogle Scholar
  11. 11.
    Mao Y, Yu D, Xu C, Liu F, Li H, Zhu Z (2014) The fate of osteophytes in the superolateral region of the acetabulum after total hip arthroplasty. J Arthroplasty 29(12):2262–2266.  https://doi.org/10.1016/j.arth.2014.04.017 CrossRefPubMedGoogle Scholar
  12. 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. 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
  14. 14.
    Kurtz WB, Ecker TM, Reichmann WM, Murphy SB (2010) Factors affecting bony impingement in hip arthroplasty. J Arthroplasty 25(4):624–634 e621–622.  https://doi.org/10.1016/j.arth.2009.03.024 CrossRefPubMedGoogle Scholar
  15. 15.
    Ha YC, Yoo JJ, Lee YK, Kim JY, Koo KH (2012) Acetabular component positioning using anatomic landmarks of the acetabulum. Clin Orthop Relat Res 470(12):3515–3523.  https://doi.org/10.1007/s11999-012-2460-y CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Park MS, Kim SJ, Chung CY, Choi IH, Lee SH, Lee KM (2010) Statistical consideration for bilateral cases in orthopaedic research. J Bone Jt Surg Am 92(8):1732–1737.  https://doi.org/10.2106/JBJS.I.00724 CrossRefGoogle Scholar
  17. 17.
    Hauser DL, Fox JC, Sukin D, Mudge B, Coutts RD (1997) Anatomic variation of structural properties of periacetabular bone as a function of age. A quantitative computed tomography study. J Arthroplasty 12(7):804–811CrossRefPubMedGoogle Scholar
  18. 18.
    Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Jt Surg Am 69(8):1169–1176CrossRefGoogle Scholar
  19. 19.
    Miller F, Merlo M, Liang Y, Kupcha P, Jamison J, Harcke HT (1993) Femoral version and neck shaft angle. J Pediatr Orthop 13(3):382–388CrossRefPubMedGoogle Scholar
  20. 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. 21.
    No author listed (2016) Openmesh, data structure for mesh. http://www.openmesh.org. Accessed 30 June 2016
  22. 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
  23. 23.
    Kessler O, Patil S, Wirth S, Mayr E, Colwell CW Jr, D’Lima DD (2008) Bony impingement affects range of motion after total hip arthroplasty: a subject-specific approach. J Orthop Res 26(4):443–452.  https://doi.org/10.1002/jor.20541 CrossRefPubMedGoogle Scholar
  24. 24.
    Dorr LD, Malik A, Dastane M, Wan Z (2009) Combined anteversion technique for total hip arthroplasty. Clin Orthop Relat Res 467(1):119–127.  https://doi.org/10.1007/s11999-008-0598-4 CrossRefPubMedGoogle Scholar
  25. 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
  26. 26.
    Bergen Gvd (1997) Efficient collision detection of complex deformable models using AABB trees. J Graph Tools 2(4):1–13CrossRefGoogle Scholar
  27. 27.
    No author listed (2016) Qt, Cross-platform software development. https://www.qt.io. Accessed 30 June 2016
  28. 28.
    No author listed (2015) libQGLViewer, OpenGL 3D viewers for Qt. http://libqglviewer.com. Accessed 30 June 2016
  29. 29.
    Hemmerich A, Brown H, Smith S, Marthandam SS, Wyss UP (2006) Hip, knee, and ankle kinematics of high range of motion activities of daily living. J Orthop Res 24(4):770–781.  https://doi.org/10.1002/jor.20114 CrossRefPubMedGoogle Scholar
  30. 30.
    Nadzadi ME, Pedersen DR, Yack HJ, Callaghan JJ, Brown TD (2003) Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. J Biomech 36(4):577–591CrossRefPubMedGoogle Scholar
  31. 31.
    Ko BH, Yoon YS (2008) Optimal orientation of implanted components in total hip arthroplasty with polyethylene on metal articulation. Clin Biomech (Bristol Avon) 23(8):996–1003.  https://doi.org/10.1016/j.clinbiomech.2008.04.012 CrossRefGoogle Scholar
  32. 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. 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
  34. 34.
    Vendittoli PA, Ganapathi M, Nuno N, Plamondon D, Lavigne M (2007) Factors affecting hip range of motion in surface replacement arthroplasty. Clin Biomech (Bristol Avon) 22(9):1004–1012.  https://doi.org/10.1016/j.clinbiomech.2007.07.007 CrossRefGoogle Scholar
  35. 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. 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

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Jung-Taek Kim
    • 1
  • Jusung Lee
    • 2
  • Young-Kyun Lee
    • 3
  • Yong-Chan Ha
    • 4
  • Ye-Yeon Won
    • 1
  • Kunwoo Lee
    • 2
  • Vikas Khanduja
    • 5
  • Kyung-Hoi Koo
    • 3
  1. 1.Department of Orthopaedic Surgery, Ajou University School of MedicineAjou Medical Center HospitalSuwonSouth Korea
  2. 2.Human centered CAD Laboratory, School of Mechanical and Aerospace EngineeringSeoul National UniversitySeoulSouth Korea
  3. 3.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnamSouth Korea
  4. 4.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea
  5. 5.Department of Trauma and OrthopaedicsAddenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation TrustCambridgeUnited Kingdom

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