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 KooEmail author
Hip Arthroplasty



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.


Hip 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.

Ethical approval

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


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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
    Email author
  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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