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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 6, 839-845.
doi: 10.1302/0301-620X.89B6.18644  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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A computer model of the position of the combined component in the prevention of impingement in total hip replacement

W. K. Barsoum, MD, Orthopaedic Surgeon1; R. W. Patterson, MD, MPH (Master of Public Health), Resident Physician1; C. Higuera, MD, Resident Physician1; A. K. Klika, MS, Research Assistant1; V. E. Krebs, MD, Orthopaedic Surgeon1; and R. Molloy, MD, Orthopaedic Surgeon1

1 Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.

Correspondence should be sent to Mr W. K. Barsoum; e-mail: barsouw{at}ccf.org

Dislocation remains a major concern after total hip replacement, and is often attributed to malposition of the components. The optimum position for placement of the components remains uncertain. We have attempted to identify a relatively safe zone in which movement of the hip will occur without impingement, even if one component is positioned incorrectly. A three-dimensional computer model was designed to simulate impingement and used to examine 125 combinations of positioning of the components in order to allow maximum movement without impingement. Increase in acetabular and/or femoral anteversion allowed greater internal rotation before impingement occurred, but decreases the amount of external rotation. A decrease in abduction of the acetabular components increased internal rotation while decreasing external rotation. Although some correction for malposition was allowable on the opposite side of the joint, extreme degrees could not be corrected because of bony impingement.

We introduce the concept of combined component position, in which anteversion and abduction of the acetabular component, along with femoral anteversion, are all defined as critical elements for stability.




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The use of ultrasound in acquisition of the anterior pelvic plane in computer-assisted total hip replacement: A CADAVER STUDY
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eLetters:

Read all eLetters

The concept of combined component position in total hip arthroplasty
Brigitte M Jolles, et al.
J Bone Joint Surg Br Online, 13 Sep 2007 [Full text]
A computer model of the position of the combined component in the prevention of impingement
B Michael Wroblewski
J Bone Joint Surg Br Online, 11 Oct 2007 [Full text]

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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General