Skip to main content
SpringerLink
Log in

The 2014 Frank Stinchfield Award: The ‘Landing Zone’ for Wear and Stability in Total Hip Arthroplasty Is Smaller Than We Thought: A Computational Analysis

  • Symposium: 2014 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Positioning of total hip bearings involves tradeoffs, because cup orientations most favorable in terms of stability are not necessarily ideal in terms of reduction of contact stress and wear potential. Previous studies and models have not addressed these potentially competing considerations for optimal total hip arthroplasty (THA) function.

Questions/purposes

We therefore asked if component positioning in total hips could be addressed in terms of balancing bearing surface wear and stability. Specifically, we sought to identify acetabular component inclination and anteversion orientation, which simultaneously resulted in minimal wear while maximizing construct stability, for several permutations of femoral head diameter and femoral stem anteversion.

Methods

A validated metal-on-metal THA finite element (FE) model was used in this investigation. Five dislocation-prone motions as well as gait were considered as were permutations of femoral anteversion (0°–30°), femoral head diameter (32–48 mm), cup inclination (25°–75°), and cup anteversion (0°–50°), resulting in 4320 distinct FE simulations. A novel metric was developed to identify a range of favorable cup orientations (so-called “landing zone”) by considering both surface wear and component stability.

Results

When considering both wear and stability with equal weight, ideal cup position was more restrictive than the historically defined safe zone and was substantially more sensitive to cup anteversion than to inclination. Ideal acetabular positioning varied with both femoral head diameter and femoral version. In general, ideal cup inclination decreased with increased head diameter (approximately 0.5° per millimeter increase in head diameter). Additionally, ideal inclination increased with increased values of femoral anteversion (approximately 0.3° per degree increase in stem anteversion). Conversely, ideal cup anteversion increased with increased femoral head diameter (0.3° per millimeter increase) and decreased with increased femoral stem anteversion (approximately 0.3° per degree increase). Regressions demonstrated strong correlations between optimal cup inclination versus head diameter (Pearson’s r = −0.88), between optimal cup inclination versus femoral anteversion (r = 0.96), between optimal cup anteversion versus head diameter (r = 0.99), and between optimal cup anteversion and femoral anteversion (r = −0.98). For a 36-mm cup with a 20° anteverted stem, the ideal cup orientation was 46° ± 12° inclination and 15° ± 4° anteversion.

Conclusions

The range of cup orientations that maximized stability and minimized wear (so-called “landing zone”) was substantially smaller than historical guidelines and specifically did not increase with increased head size, challenging the presumption that larger heads are more forgiving. In particular, when the cup is oriented to improve not only stability, but also wear in the model, there was little or no added stability achieved by the use of larger femoral heads. Additionally, ideal cup positioning was more sensitive to cup anteversion than to inclination.

Clinical Relevance

Positioning THA bearings involves tradeoffs regarding stability and long-term bearing wear. Cup positions most favorable to minimization of wear such as low inclination and elevated anteversion were detrimental in terms of construct stability. Orientations were identified that best balanced the competing considerations of wear and stability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1A–B
Fig. 2A–B
Fig. 3
Fig. 4A–F
Fig. 5A–D
Fig. 6A–B
Fig. 7A–B
Fig. 8A–E
Fig. 9A–B

Similar content being viewed by others

References

  1. Ackland M, Bourne W, Uhthoff H. Anteversion of the acetabular cup. Measurement of angle after total hip replacement. J Bone Joint Surg Br. 1986;68:409–413.

    CAS  PubMed  Google Scholar 

  2. Anthony P, Gie G, Howie C, Ling R. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties. J Bone Joint Surg Br. 1990;72:971–979.

    CAS  PubMed  Google Scholar 

  3. Archard J. Contact and rubbing of flat surfaces. J Appl Phys. 1953;24:981–988.

    Article  Google Scholar 

  4. Barrack RL, Krempec JA, Clohisy JC, McDonald DJ, Ricci WM, Ruh EL, Nunley RM. Accuracy of acetabular component position in hip arthroplasty. J Bone Joint Surg Am. 2013;95:1760–1768.

    Article  PubMed  Google Scholar 

  5. Barrack RL, Lavernia C, Ries M, Thornberry R, Tozakoglou E. Virtual reality computer animation of the effect of component position and design on stability after total hip arthroplasty. Orthop Clin North Am. 2001;32:569–577.

    Article  CAS  PubMed  Google Scholar 

  6. Bernstein M, Walsh A, Petit A, Zukor DJ, Antoniou J. Femoral head size does not affect ion values in metal-on-metal total hips. Clin Orthop Relat Res. 2011;469:1642–1650.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Biedermann R, Tonin A, Krismer M, Rachbauer F, Eibl G, Stöckl B. Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J Bone Joint Surg Br. 2005;87:762–769.

    Article  CAS  PubMed  Google Scholar 

  8. Bono JV, Sanford L, Toussaint JT. Severe polyethylene wear in total hip arthroplasty: observations from retrieved AML PLUS hip implants with an ACS polyethylene liner. J Arthroplasty. 1994;9:119–125.

    Article  CAS  PubMed  Google Scholar 

  9. Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91:128–133.

    Article  PubMed  Google Scholar 

  10. Brockett C, Williams S, Jin Z, Isaac G, Fisher J. Friction of total hip replacements with different bearings and loading conditions. J Biomed Mater Res B Appl Biomater. 2007;81:508–515.

    Article  PubMed  Google Scholar 

  11. Brodner W, Grübl A, Jankovsky R, Meisinger V, Lehr S, Gottsauner-Wolf F. Cup inclination and serum concentration of cobalt and chromium after metal-on-metal total hip arthroplasty. J Arthroplasty. 2004;19:66–70.

    Article  PubMed  Google Scholar 

  12. Browne JA, Bechtold CD, Berry DJ, Hanssen AD, Lewallen DG. Failed metal-on-metal hip arthroplasties: a spectrum of clinical presentations and operative findings. Clin Orthop Relat Res. 2010;468:2313–2320.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Cooper HJ, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM, Jacobs JJ. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94:1655–1661.

    PubMed  Google Scholar 

  14. De Haan R, Pattyn C, Gill HS, Murray DW, Campbell PA, De Smet K. Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br. 2008;90:1291–1297.

    Article  PubMed  Google Scholar 

  15. Del Schutte H Jr, Lipman AJ, Bannar SM, Livermore JT, Ilstrup D, Morrey BF. Effects of acetabular abduction on cup wear rates in total hip arthroplasty. J Arthroplasty. 1998;13:621–626.

    Article  PubMed  Google Scholar 

  16. Dorr LD, Wan Z, Malik A, Zhu J, Dastane M, Deshmane P. A comparison of surgeon estimation and computed tomographic measurement of femoral component anteversion in cementless total hip arthroplasty. J Bone Joint Surg Am. 2009;91:2598–2604.

    Article  PubMed  Google Scholar 

  17. Dorr LD, Wolf AW, Chandler R, Conaty JP. Classification and treatment of dislocations of total hip arthroplasty. Clin Orthop Relat Res. 1983;173:151–158.

    PubMed  Google Scholar 

  18. Ebramzadeh E, Campbell PA, Takamura KM, Lu Z, Sangiorgio SN, Kalma JJ, De Smet KA, Amstutz HC. Failure modes of 433 metal-on-metal hip implants: how, why, and wear. Orthop Clin North Am. 2011;42:241–250.

    Article  PubMed  Google Scholar 

  19. Elkins JM, Callaghan JJ, Brown TD. Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res. 2014;472:529–542.

    Article  PubMed  Google Scholar 

  20. Elkins JM, Kruger KM, Pedersen DR, Callaghan JJ, Brown TD. Edge-loading severity as a function of cup lip radius in metal-on-metal total hips—a finite element analysis. J Orthop Res. 2012;30:169–177.

    Article  PubMed  Google Scholar 

  21. Elkins JM, O’Brien MK, Stroud NJ, Pedersen DR, Callaghan JJ, Brown TD. Hard-on-hard total hip impingement causes extreme contact stress concentrations. Clin Orthop Relat Res. 2011;469:454–463.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Elkins JM, Pedersen DR, Callaghan JJ, Brown TD. Bone-on-bone versus hardware impingement in total hips: a biomechanical study. Iowa Orthop J. 2012;32:17–21.

    PubMed Central  PubMed  Google Scholar 

  23. Elkins JM, Stroud NJ, Rudert MJ, Tochigi Y, Pedersen DR, Ellis BJ, Callaghan JJ, Weiss JA, Brown TD. The capsule’s contribution to total hip construct stability—a finite element analysis. J Orthop Res. 2011;29:1642–1648.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Griffin WL, Nanson CJ, Springer BD, Davies MA, Fehring TK. Reduced articular surface of one-piece cups: a cause of runaway wear and early failure. Clin Orthop Relat Res. 2010;468:2328–2332.

    Article  PubMed Central  PubMed  Google Scholar 

  25. Jolles BM, Zangger P, Leyvraz PF. Factors predisposing to dislocation after primary total hip arthroplasty. J Arthroplasty. 2002;17:282–288.

    Article  CAS  PubMed  Google Scholar 

  26. Kennedy J, Rogers W, Soffe K, Sullivan R, Griffen D, Sheehan L. Effect of acetabular component orientation on recurrent dislocation, pelvic osteolysis, polyethylene wear, and component migration. J Arthroplasty. 1998;13:530–534.

    Article  CAS  PubMed  Google Scholar 

  27. Kluess D, Martin H, Mittelmeier W, Schmitz KP, Bader R. Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement. Med Eng Phys. 2007;29:465–471.

    Article  PubMed  Google Scholar 

  28. Langton D, Jameson S, Joyce T, Gandhi J, Sidaginamale R, Mereddy P, Lord J, Nargol A. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br. 2011;93:1011–1016.

    Article  CAS  PubMed  Google Scholar 

  29. Langton D, Jameson S, Joyce T, Webb J, Nargol A. The effect of component size and orientation on the concentrations of metal ions after resurfacing arthroplasty of the hip. J Bone Joint Surg Br. 2008;90:1143–1151.

    Article  CAS  PubMed  Google Scholar 

  30. Langton D, Sprowson A, Joyce T, Reed M, Carluke I, Partington P, Nargol A. Blood metal ion concentrations after hip resurfacing arthroplasty. J Bone Joint Surg Br. 2009;91:1287–1295.

    Article  CAS  PubMed  Google Scholar 

  31. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR. Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am. 1978;60:217–220.

    CAS  PubMed  Google Scholar 

  32. Lusty PJ, Watson A, Tuke MA, Walter WL, Walter WK, Zicat B. Wear and acetabular component orientation in third generation alumina-on-alumina ceramic bearings: an analysis of 33 retrievals. J Bone Joint Surg Br. 2007;89:1158–1164.

    Article  CAS  PubMed  Google Scholar 

  33. McCollum DE, Gray WJ. Dislocation after total hip arthroplasty. Causes and prevention. Clin Orthop Relat Res. 1990;261:159–170.

    PubMed  Google Scholar 

  34. Morlock M, Schneider E, Bluhm A, Vollmer M, Bergmann G, Muller V, Honl M. Duration and frequency of every day activities in total hip patients. J Biomech. 2001;34:873–881.

    Article  CAS  PubMed  Google Scholar 

  35. Murray D. The definition and measurement of acetabular orientation. J Bone Joint Surg Br. 1993;75:228–232.

    CAS  PubMed  Google Scholar 

  36. Nadzadi ME, Pedersen DR, Yack HJ, Callaghan JJ, Brown TD. Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. J Biomech. 2003;36:577–591.

    Article  PubMed  Google Scholar 

  37. Ong K, Mowat F, Chan N, Lau E, Halpern M, Kurtz S. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res. 2006;446:22–28.

    Article  CAS  PubMed  Google Scholar 

  38. Pierchon F, Pasquier G, Cotten A, Fontaine C, Clarisse J, Duquennoy A. Causes of dislocation of total hip arthroplasty. CT study of component alignment. J Bone Joint Surg Br. 1994;76:45–48.

    CAS  PubMed  Google Scholar 

  39. Schmalzried T, Jasty M, Harris W. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992;74:849–863.

    CAS  PubMed  Google Scholar 

  40. Schmalzried TP, Guttmann D, Grecula M, Amstutz HC. The relationship between the design, position, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76:677–688.

    CAS  PubMed  Google Scholar 

  41. Scifert CF, Brown TD, Pedersen DR, Callaghan JJ. A finite element analysis of factors influencing total hip dislocation. Clin Orthop Relat Res. 1998;355:152–162.

    Article  PubMed  Google Scholar 

  42. Widmer KH, Zurfluh B. Compliant positioning of total hip components for optimal range of motion. J Orthop Res. 2004;22:815–821.

    Article  PubMed  Google Scholar 

  43. Wines AP, McNicol D. Computed tomography measurement of the accuracy of component version in total hip arthroplasty. J Arthroplasty. 2006;21:696–701.

    Article  PubMed  Google Scholar 

  44. Yoshimine F. The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. J Biomech. 2006;39:1315–1323.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Dr Douglas Pedersen provided valuable engineering collaboration in several earlier phases of FE model development. We appreciate the assistance of Dr Steve Liu in preparation of this manuscript. Helpful technical data regarding implant design parameters were provided by DePuy, Inc.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    Jacob M. Elkins MD, PhD, John J. Callaghan MD & Thomas D. Brown PhD

  2. Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA

    John J. Callaghan MD & Thomas D. Brown PhD

  3. Veterans Administration Medical Center, Iowa City, IA, USA

    John J. Callaghan MD

  4. Department of Orthopaedics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, USA

    Jacob M. Elkins MD, PhD

Authors
  1. Jacob M. Elkins MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John J. Callaghan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas D. Brown PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jacob M. Elkins MD, PhD.

Additional information

The institutions of one or more of the authors have received, during the study period, funding from the National Institutes of Health (Grants AR46601 and AR53553) (TDB), the Veterans Administration (JJC, TDB), and the National Center for Research Resources (Grant UL1 RR024979) (JME). One of the authors (JJC) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of more than USD 1,000,001, from DePuy Orthopaedics, Inc (Warsaw, IN, USA). One of the authors (TDB) certifies that he or she, or a member of his or her immediate family, has received or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000, from Smith & Nephew, Inc (Memphis, TN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Elkins, J.M., Callaghan, J.J. & Brown, T.D. The 2014 Frank Stinchfield Award: The ‘Landing Zone’ for Wear and Stability in Total Hip Arthroplasty Is Smaller Than We Thought: A Computational Analysis. Clin Orthop Relat Res 473, 441–452 (2015). https://doi.org/10.1007/s11999-014-3818-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11999-014-3818-0

Keywords

Search

Navigation