International Orthopaedics

, Volume 40, Issue 12, pp 2495–2504 | Cite as

Current standard rules of combined anteversion prevent prosthetic impingement but ignore osseous contact in total hip arthroplasty

  • Markus Weber
  • Michael Woerner
  • Benjamin Craiovan
  • Florian Voellner
  • Michael Worlicek
  • Hans-Robert Springorum
  • Joachim Grifka
  • Tobias Renkawitz
Original Paper

Abstract

Purpose

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).

Methods

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.

Results

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).

Conclusion

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.

Keywords

Combined anteversion Impingement Range of motion Outcome Total hip arthroplasty 

Supplementary material

264_2016_3171_MOESM1_ESM.docx (39 kb)
ESM 1(DOCX 38 kb)
264_2016_3171_MOESM2_ESM.docx (35 kb)
ESM 2(DOCX 34 kb)

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Copyright information

© SICOT aisbl 2016

Authors and Affiliations

  • Markus Weber
    • 1
  • Michael Woerner
    • 1
  • Benjamin Craiovan
    • 1
  • Florian Voellner
    • 1
  • Michael Worlicek
    • 1
  • Hans-Robert Springorum
    • 1
  • Joachim Grifka
    • 1
  • Tobias Renkawitz
    • 1
  1. 1.Department of Orthopaedic SurgeryRegensburg University Medical CentreBad AbbachGermany

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