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.
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