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Using preoperative planning software to assess the effect of head length on prosthetic range of motion in a high-risk population: a three-dimensional modeling study

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Abstract

Purpose

Concurrent use of minus heads with tapered stems in total hip arthroplasty (THA) decreases the prosthetic range of motion (pROM). Three-dimensional preoperative templating can simulate the location of the impingement by taking the hip through a virtual pROM. This enables surgeons to simulate how modifying the type of implant, orientation, and position influences impingement. We hypothesized that CT-based modeling would result in a decrease in the pROM, thereby increasing the risk of impingement when minus heads are used.

Methods

Forty-three patients who underwent robotic-assisted primary THAs were included. Prosthetic head diameter (32/36-mm) and head length (minus/zero/plus) were the predictors. Maximum external rotation at full hip extension and internal rotation at 90° and 100° of flexion prior to prosthetic impingement were the outcome variables. A CT-based preoperative planning software was used for pROM estimation and impingement detection.

Results

Significant decreases in pROM were found for both head diameters as the head length decreased and was more pronounced in external rotation during full hip extension (changes of 2.8–3.4° for the 32-mm head and 1.6–2.8° for the 36-mm head (p = 0.00011)). The magnitude of loss in pROM when using a minus head was larger than the gain provided by a plus head in tapered stems (p < 0.0001).

Conclusion

Head length affects the offset and pROM. When the use of minus heads or smaller heads is indicated, 3D preoperative templating for assessing postoperative pROM and impingement provides surgeons with options to consider alternate surgical plans offering additional assurance and protection from dislocation.

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Funding

1. Aidin Eslam Pour, MD, MS, FAAOS received funding from:

Agency: National Institute of Arthritis, Musculoskeletal and Skin Diseases.

I.D.#: 5 K08 AR073933

Agency: Orthopaedic Research and Education Foundation.

I.D.#: 22–071

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Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT, 06510, USA

    Aidin Eslam Pour, Wei Shao Tung, Claire A. Donnelley, Steven M. Tommasini & Daniel Wiznia

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  1. Aidin Eslam Pour
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  2. Wei Shao Tung
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  3. Claire A. Donnelley
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  4. Steven M. Tommasini
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  5. Daniel Wiznia
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [Aidin Eslam Pour and Wei Shao Tung and Claire A Donnelley]. The first draft of the manuscript was written by [Aidin Eslam Pour and Wei Shao Tung and Claire A Donnelley] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Aidin Eslam Pour.

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Ethics approval

This retrospective study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Yale University and study was found exempt (Date: 2/22/2022 /No: 2000032304).

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Consent to participate was not found necessary to obtain for this retrospective chart/imaging review study.

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Consent to publish was not found necessary to obtain for this retrospective chart/imaging review study.

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The authors have no relevant financial or non-financial interests to disclose.

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Eslam Pour, A., Tung, W.S., Donnelley, C.A. et al. Using preoperative planning software to assess the effect of head length on prosthetic range of motion in a high-risk population: a three-dimensional modeling study. International Orthopaedics (SICOT) (2024). https://doi.org/10.1007/s00264-024-06191-8

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