Does Prosthetic or Bony Impingement Occur More Often in Total Hip Arthroplasty: A Dynamic Preoperative Analysis.

Autor: Vigdorchik JM; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY., Sharma AK; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY., Madurawe CS; Corin Group, Cirencester, United Kingdom., Elbuluk AM; Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, Adult Reconstruction and Joint Replacement Service, New York, NY., Baré JV; Melbourne Orthopaedic Group, Melbourne, Victoria, Australia., Pierrepont JW; Corin Group, Cirencester, United Kingdom.
Jazyk: angličtina
Zdroj: The Journal of arthroplasty [J Arthroplasty] 2020 Sep; Vol. 35 (9), pp. 2501-2506. Date of Electronic Publication: 2020 May 11.
DOI: 10.1016/j.arth.2020.05.009
Abstrakt: Background: Impingement is a leading cause for instability resulting in revision total hip arthroplasty (THA). Impingement can be prosthetic, bony, or soft tissue. The purpose of this study is to investigate, using a virtual simulation, whether bony or prosthetic impingement presents first in well-positioned THAs.
Methods: Twenty-three patients requiring THA were planned for a ceramic-on-poly cementless construct using dynamic planning software. Cups were orientated at 45° inclination and 25° anteversion when standing. Femoral components and neck lengths were positioned to reproduce native anteversion and match contralateral leg length and offset. The type and location of impingement was then recorded with recreation of anterior and posterior impingement during standard and extreme ranges of motion (ROM).
Results: In standard ROM, flexion produced both prosthetic and bony impingement and extension resulted in prosthetic impingement in models with lipped liners. In extreme ROM, anterior impingement was 78% bony in 32-mm articulations, and 88% bony in 36-mm articulations. Posterior impingement was 65% prosthetic in 32-mm articulations, and 55% prosthetic in 36-mm articulations. Dual mobility cups showed the greatest risk of posterior prosthetic impingement in hyperextension (74%).
Conclusion: In standard ROM, both bony and prosthetic impingement occurred in flexion, while prosthetic impingement occurred in extension in models with lipped liners. In hyperextension, prosthetic impingement was more common than bony impingement, and was exclusively the cause of impingement when a lip was used. In flexion, impingement was primarily bony with the use of a 36-mm head. The risk of posterior prosthetic impingement was greatest with dual mobility cups.
Level of Evidence: 3.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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