Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation
Evaluation of optimal implant alignment in total hip arthroplasty based on postoperative range of motion simulation
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DOI：
10.1016/j.clinbiomech.2021.105555
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发表时间：
2022-01-10
影响因子：
1.8
通讯作者：
Nakashima, Yasuharu
中科院分区：
文献类型：
--
作者：
Harada, Satoru;Hamai, Satoshi;Nakashima, Yasuharu
背景：全髋关节置换术后脱位是翻修手术的常见原因。本研究旨在通过模拟术后关节活动范围来确定全髋关节置换术中植入物的最佳对线。方法：所有手术均采用后外侧入路，采用联合前倾股骨柄和髋臼杯技术。使用术后计算机断层扫描在79个置换髋关节中模拟了无植入物撞击的最大活动度，并评估了先前研究定义的所需活动度的实现情况。结果：髋臼杯倾斜度和前倾角、股骨柄前倾角和联合前倾角分别为37.6度、20.1度、26.2度和46.3度。屈曲、伸展、屈曲90 °时内旋和外旋的最大活动度分别为131.8度、42.3度、56.4度和64.5度。在所有置换的髋关节中，分别有96%、86%、92%和96%的髋关节实现了前屈>110 °、后伸>30 °、屈曲90 °时内旋>30 °和外旋>30 °。无撞击活动度的最佳植入物对线为髋臼杯倾斜34度-43度，髋臼杯前倾18度-26度，股骨柄前倾17度-29度，以及组合前倾35度-56度。髋臼杯和股骨柄前倾角与术后活动度有显著相关性。解释：外科医生可以获得有价值的见解，了解最佳髋臼杯和股骨柄对线，以进行术后活动度模拟。
Background: Dislocation after total hip arthroplasty is a frequent cause of revision surgery. This study was performed to determine the optimal implant alignment in total hip arthroplasty by simulating the postoperative range of motion.Methods: All operations were performed via posterolateral approach using combined anteversion of the stem and cup technique. Maximum range of motion without implant impingement was simulated in 79 replaced hips using postoperative computed tomography and the achievement of the required range of motion defined by previous studies was assessed. Optimal cup and stem alignment for impingement-free range of motion were statistically determined using the receiver operator coefficient curve.Findings: Cup inclination and anteversion, stem anteversion, and combined anteversion were 37.6 degrees, 20.1 degrees, 26.2 degrees, and 46.3 degrees, respectively. Maximum range of motion in flexion, extension, internal rotation at 90 degrees of flexion, and external rotation were 131.8 degrees, 42.3 degrees, 56.4 degrees, and 64.5 degrees, respectively. Flexion >110 degrees, extension >30 degrees, internal rotation >30 degrees at 90 degrees of flexion, and external rotation >30 degrees were fulfilled by 96%, 86%, 92%, and 96% of all replaced hips, respectively. Optimal implant alignment for impingement-free range of motion was 34 degrees-43 degrees of cup inclination, 18 degrees-26 degrees of cup anteversion, 17 degrees-29 degrees of stem anteversion, and 35 degrees-56 degrees of combined anteversion. Both cup and stem anteversion showed significant relationship with postoperative range of motion.Interpretation: Surgeons could gain valuable insights into optimal cup and stem alignment to perform postoperative range of motion simulations.