Does Prosthetic or Bony Impingement Occur More Often in Total Hip Arthroplasty: A Dynamic Preoperative Analysis
| Autor: | Abhinav K. Sharma, Jim Pierrepont, Jonathan M. Vigdorchik, Chameka S. Madurawe, J Bare, Ameer M. Elbuluk |
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| Rok vydání: | 2020 |
| Předmět: |
Orthodontics
Reoperation 030222 orthopedics business.industry Arthroplasty Replacement Hip Leg length Soft tissue Anterior impingement Dual mobility Dynamic planning 03 medical and health sciences 0302 clinical medicine Medicine Humans Orthopedics and Sports Medicine Hip Joint Hip Prosthesis Joint Diseases Range of Motion Articular business Total hip arthroplasty |
| Zdroj: | The Journal of arthroplasty. 35(9) |
| ISSN: | 1532-8406 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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