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The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty

BACKGROUND: There is a complex interaction among acetabular component position and antetorsion of the femoral stem in determining the maximum, impingement-free prosthetic range-of-motion (ROM) in total hip arthroplasty (THA). By insertion into the femoral canal, stems of any geometry follow the natu...

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Autores principales: Renkawitz, Tobias, Haimerl, Martin, Dohmen, Lars, Gneiting, Sabine, Lechler, Philipp, Woerner, Michael, Springorum, Hans-Robert, Weber, Markus, Sussmann, Patrick, Sendtner, Ernst, Grifka, Joachim
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416712/
https://www.ncbi.nlm.nih.gov/pubmed/22559740
http://dx.doi.org/10.1186/1471-2474-13-65
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author Renkawitz, Tobias
Haimerl, Martin
Dohmen, Lars
Gneiting, Sabine
Lechler, Philipp
Woerner, Michael
Springorum, Hans-Robert
Weber, Markus
Sussmann, Patrick
Sendtner, Ernst
Grifka, Joachim
author_facet Renkawitz, Tobias
Haimerl, Martin
Dohmen, Lars
Gneiting, Sabine
Lechler, Philipp
Woerner, Michael
Springorum, Hans-Robert
Weber, Markus
Sussmann, Patrick
Sendtner, Ernst
Grifka, Joachim
author_sort Renkawitz, Tobias
collection PubMed
description BACKGROUND: There is a complex interaction among acetabular component position and antetorsion of the femoral stem in determining the maximum, impingement-free prosthetic range-of-motion (ROM) in total hip arthroplasty (THA). By insertion into the femoral canal, stems of any geometry follow the natural anterior bow of the proximal femur, creating a sagittal Femoral Tilt (FT). We sought to study the incidence of FT as measured on postoperative computed tomography scans and its influence on impingement-free ROM in THA. METHODS: The incidence of the postoperative FT was evaluated on 40 computed tomography scans after cementless THA. With the help of a three-dimensional computer model of the hip, we then systematically analyzed the effects of FT on femoral antetorsion and its influence on calculations for a ROM maximized and impingement-free compliant stem/cup orientation. RESULTS: The mean postoperative FT on CT scans was 5.7° ± 1.8°. In all tests, FT significantly influenced the antetorsion values. Re-calculating the compliant component positions according to the concept of combined anteversion with and without the influence of FT revealed that the zone of compliance could differ by more than 200%. For a 7° change in FT, the impingement-free cup position differed by 4° for inclination when the same antetorsion was used. CONCLUSIONS: A range-of-motion optimized cup position in THA cannot be calculated based on antetorsion values alone. The FT has a significant impact on recommended cup positions within the concept of “femur first” or “combined anteversion”. Ignoring FT may pose an increased risk of impingement as well as dislocation.
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spelling pubmed-34167122012-08-11 The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty Renkawitz, Tobias Haimerl, Martin Dohmen, Lars Gneiting, Sabine Lechler, Philipp Woerner, Michael Springorum, Hans-Robert Weber, Markus Sussmann, Patrick Sendtner, Ernst Grifka, Joachim BMC Musculoskelet Disord Research Article BACKGROUND: There is a complex interaction among acetabular component position and antetorsion of the femoral stem in determining the maximum, impingement-free prosthetic range-of-motion (ROM) in total hip arthroplasty (THA). By insertion into the femoral canal, stems of any geometry follow the natural anterior bow of the proximal femur, creating a sagittal Femoral Tilt (FT). We sought to study the incidence of FT as measured on postoperative computed tomography scans and its influence on impingement-free ROM in THA. METHODS: The incidence of the postoperative FT was evaluated on 40 computed tomography scans after cementless THA. With the help of a three-dimensional computer model of the hip, we then systematically analyzed the effects of FT on femoral antetorsion and its influence on calculations for a ROM maximized and impingement-free compliant stem/cup orientation. RESULTS: The mean postoperative FT on CT scans was 5.7° ± 1.8°. In all tests, FT significantly influenced the antetorsion values. Re-calculating the compliant component positions according to the concept of combined anteversion with and without the influence of FT revealed that the zone of compliance could differ by more than 200%. For a 7° change in FT, the impingement-free cup position differed by 4° for inclination when the same antetorsion was used. CONCLUSIONS: A range-of-motion optimized cup position in THA cannot be calculated based on antetorsion values alone. The FT has a significant impact on recommended cup positions within the concept of “femur first” or “combined anteversion”. Ignoring FT may pose an increased risk of impingement as well as dislocation. BioMed Central 2012-05-04 /pmc/articles/PMC3416712/ /pubmed/22559740 http://dx.doi.org/10.1186/1471-2474-13-65 Text en Copyright ©2012 Renkawitz et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Renkawitz, Tobias
Haimerl, Martin
Dohmen, Lars
Gneiting, Sabine
Lechler, Philipp
Woerner, Michael
Springorum, Hans-Robert
Weber, Markus
Sussmann, Patrick
Sendtner, Ernst
Grifka, Joachim
The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title_full The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title_fullStr The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title_full_unstemmed The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title_short The association between Femoral Tilt and impingement-free range-of-motion in total hip arthroplasty
title_sort association between femoral tilt and impingement-free range-of-motion in total hip arthroplasty
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3416712/
https://www.ncbi.nlm.nih.gov/pubmed/22559740
http://dx.doi.org/10.1186/1471-2474-13-65
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