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

  • Hip Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

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.

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References

  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

    Article  Google Scholar 

  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):890–898

    Article  Google Scholar 

  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

    Article  Google Scholar 

  4. Padgett DE, Warashina H (2004) The unstable total hip replacement. Clin Orthop Relat Res 420:72–79

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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):45–48

    Article  CAS  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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):1874–1877

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  Google Scholar 

  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):804–811

    Article  CAS  Google Scholar 

  18. Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Jt Surg Am 69(8):1169–1176

    Article  CAS  Google Scholar 

  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):382–388

    Article  CAS  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  21. No author listed (2016) Openmesh, data structure for mesh. http://www.openmesh.org. Accessed 30 June 2016

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  26. Bergen Gvd (1997) Efficient collision detection of complex deformable models using AABB trees. J Graph Tools 2(4):1–13

    Article  Google Scholar 

  27. No author listed (2016) Qt, Cross-platform software development. https://www.qt.io. Accessed 30 June 2016

  28. No author listed (2015) libQGLViewer, OpenGL 3D viewers for Qt. http://libqglviewer.com. Accessed 30 June 2016

  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

    Article  CAS  PubMed  Google Scholar 

  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):577–591

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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):543–548

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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 166:284–291

    Google Scholar 

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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.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Ajou University School of Medicine, Ajou Medical Center Hospital, Suwon, South Korea

    Jung-Taek Kim & Ye-Yeon Won

  2. Human centered CAD Laboratory, School of Mechanical and Aerospace Engineering, Seoul National University, Seoul, South Korea

    Jusung Lee & Kunwoo Lee

  3. Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do, 13620, South Korea

    Young-Kyun Lee & Kyung-Hoi Koo

  4. Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea

    Yong-Chan Ha

  5. Department of Trauma and Orthopaedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, United Kingdom

    Vikas Khanduja

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  1. Jung-Taek Kim
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Correspondence to Kyung-Hoi Koo.

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Conflict of interest

One of the authors was an Educational Consultant of Stryker & Smith and Nephew and got a grant from Bone Therapeutics.

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

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Kim, JT., Lee, J., Lee, YK. et al. What is the tolerated width of periacetabular osteophytes to avoid impingement in cementless THA?: a three-dimensional simulation study. Arch Orthop Trauma Surg 138, 1165–1172 (2018). https://doi.org/10.1007/s00402-018-2982-1

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  • DOI: https://doi.org/10.1007/s00402-018-2982-1

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