Functional orientation of the acetabular component in ceramic-on-ceramic total hip arthroplasty and its relevance to squeaking
Functional orientation of the acetabular component in ceramic-on-ceramic total hip arthroplasty and its relevance to squeaking
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DOI：
10.1302/0301-620x.98b7.37062
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发表时间：
2016-07-01
影响因子：
4.6
通讯作者：
Shimmin, A. J.
中科院分区：
文献类型：
--
作者：
Pierrepont, J. W.;Feyen, H.;Shimmin, A. J.
目的：陶瓷对陶瓷（CoC）轴承的长期临床结果令人鼓舞。然而，有吱吱作响的风险。髋臼组件的定位指南是根据静态成像确定的，但在与边缘负荷相关的活动中，骨盆和髋臼组件的位置可能与患者仰卧时测量的位置大不相同。我们评估了髋臼部件的功能定位。患者和方法对18例髋部CoC髋在深度屈曲时出现可重复吱吱声的患者与36例无吱吱声的髋部CoC髋关节作为对照组进行研究。两组对假体的类型、仰卧时髋臼假体的方向、股骨头的大小、韧带松弛度、髋最大屈曲度和体重指数进行匹配。结果尖叫组患者从坐位开始上升时髋臼组件的平均功能性前倾明显小于对照组，分别为8.1度（-10.5度~ 36.0度）和21.1度（-1.9度~ 38.4度），差异有统计学意义（p = 0.002）。结论由于患者特有的骨盆运动学，与后缘负荷相关的活动中髋臼组件的功能取向与仰卧时不同。骨盆前倾较大的个体在深度屈曲时可能更容易发生后缘负荷和吱吱声，这是髋臼前倾功能显著降低的结果。
AimsLong-term clinical outcomes for ceramic-on-ceramic (CoC) bearings are encouraging. However, there is a risk of squeaking. Guidelines for the orientation of the acetabular component are defined from static imaging, but the position of the pelvis and thus the acetabular component during activities associated with edge-loading are likely to be very different from those measured when the patient is supine. We assessed the functional orientation of the acetabular component.Patients and MethodsA total of 18 patients with reproducible squeaking in their CoC hips during deep flexion were investigated with a control group of 36 non-squeaking CoC hips. The two groups were matched for the type of implant, the orientation of the acetabular component when supine, the size of the femoral head, ligament laxity, maximum hip flexion and body mass index.ResultsThe mean functional anteversion of the acetabular component at the point when patients initiated rising from a seated position was significantly less in the squeaking group than in the control group, 8.1 degrees (-10.5 degrees to 36.0 degrees) and 21.1 degrees (-1.9 degrees to 38.4 degrees) respectively (p = 0.002).ConclusionThe functional orientation of the acetabular component during activities associated with posterior edge-loading are different from those measured when supine due to patient-specific pelvic kinematics. Individuals with a large anterior pelvic tilt during deep flexion might be more susceptible to posterior edge-loading and squeaking as a consequence of a significant decrease in the functional anteversion of the acetabular component.