Impact of Individual Anatomy on the Benefit of cup Medialisation in Total Hip Arthroplasty

2016 ◽  
Vol 26 (6) ◽  
pp. 537-542 ◽  
Author(s):  
Alexandre Terrier ◽  
Valérie Parvex ◽  
Hannes A. Rüdiger
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Gluteus Medius ◽  
Femoral Anteversion ◽  
Patient Specific ◽  
Moment Arm ◽  
Total Hip ◽  
Moment Arms ◽  
The Moment ◽  
Anatomical Parameters

Introduction In total hip arthroplasty, cup medialisation with compensatory increase of femoral offset has been proposed to increase the moment arms of abductor muscles. However, this technique is associated with a loss of acetabular bone stock. Previous data indicates that the potential benefit is not constant among patients and is likely related to patient anatomy. Method Therefore, to be able to select patients who would benefit most from this technique, we measured several anatomical parameters of the pelvis and femur in 15 patients; and evaluated correlations between them and the changes of moment arms associated with cup medialisation. The anatomical measurements were performed on 3-D reconstructions of preoperative CT scans. The moment arms of the gluteus medius and gluteus minimus were calculated for an abduction and flexion movement using patient-specific finite element models. Results 6 anatomical parameters were correlated with muscle moment arm variations after cup medialisation. This effect was not systematic for either muscles or movements. Among all parameters, femoral anteversion was the most important parameter in explaining the effect of cup medialisation. Discussion Patients with small femoral anteversion or low-riding greater trochanter benefit more from cup medialisation in terms of moment arm increase in abduction motion.

scholarly journals Repair of Symptomatic Partial Gluteus Medius Tear During Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
Vol 10 (2) ◽  
pp. e575-e580
Author(s):  
David R. Maldonado ◽  
Samantha C. Diulus ◽  
Mitchell B. Meghpara ◽  
Rachel M. Glein ◽  
Hari K. Ankem ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Gluteus Medius ◽  
Direct Anterior Approach ◽  
Total Hip

scholarly journals Effects of rehabilitation and arthroplasty on the hip isometric muscle strength in patients with osteoarthritis of the hip

2009 ◽  
Vol 62 (5-6) ◽  
pp. 236-240 ◽  
Author(s):  
Slavica Jandric
Keyword(s):  
Muscle Strength ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Gluteus Medius ◽  
Treated Group ◽  
Early Rehabilitation ◽  
Control Group ◽  
Osteoarthritis Of The Hip ◽  
Total Hip ◽  
Tensor Fasciae Latae

Introduction Periarticular muscles have a significant role in keeping the mobility and integrity of the hip joint. The aim of this article was to investigate the effects of the total hip arthroplasty and early rehabilitation on the muscle strength. Patients Three groups of examined persons (matched in relation to musculosceletal conditions, sex, age and occupation) were included in the investigation. The first group (40 of the involved hip) and the second group (with 33 involved hips) were groups of patients with late-stage of osteoarthritis of the hip. The first group of patients was managed conservatively and the second group operatively (total cemented hip endoprosthesis was performed). The third group was control group with 123 healthy hips. Material and methods The maximal voluntary isometric strength was measured with dynamometer. The muscle strength was tested in all three groups: in the first group of patients at the beginning and at the end of the therapy and in patients of the second group 6?3 months postoperatively. Results A significant improvement of the muscle strength was noted for the flexors (t=2.45, p<0.05), musculus tensor fasciae latae (t=2.35, p<0.05), extensors (t=2.85, p<0.01), adductors (t=3.02, p<0.01), external rotators (t=3.1, p<0.01), m. gluteus medius (t=5.28, p<0.001) and internal rotators (t=5.77, p<0.001) after total hip arthroplasty and early rehabilitation in comparison to the conservatively treated group. Conclusion The muscle strength in the patients with osteoarthritis of the hip after arthroplasty was significantly higher than after rehabilitation for all hip muscles but did not reach values of the strength of the muscles in the corresponding control group.

Redesign of the Femoral Stem for a Total Hip Arthroplasty for Additive Manufacturing

2018 ◽  
Author(s):  
Bradley Hanks ◽  
Shantanab Dinda ◽  
Sanjay Joshi
Keyword(s):  
Additive Manufacturing ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Lattice Structure ◽  
Stress Shielding ◽  
Patient Specific ◽  
Hip Implants ◽  
Hip Implant ◽  
Total Hip ◽  
Multiple Materials

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

scholarly journals Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jingyang Sun ◽  
Bohan Zhang ◽  
Lei Geng ◽  
Qingyuan Zheng ◽  
Juncheng Li ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Influencing Factors ◽  
Hip Arthroplasty ◽  
Perioperative Complications ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Femoral Stem ◽  
Femoral Anteversion ◽  
Total Hip

Abstract Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

Risk Factors for Periprosthetic Femoral Fracture in Non-cemented Total Hip Arthroplasty Through the Direct Anterior Approach

2021 ◽  
pp. 155633162110508
Author(s):  
Zachary Berliner ◽  
Cameron Yau ◽  
Kenneth Jahng ◽  
Marcel A. Bas ◽  
H. John Cooper ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Hip Arthroplasty ◽  
Parkinson Disease ◽  
Hip Arthroplasty ◽  
Femoral Fracture ◽  
Categorical Variables ◽  
Patient Specific ◽  
Periprosthetic Femoral Fracture ◽  
Total Hip ◽  
Increased Risk

Background: Although total hip arthroplasty (THA) performed through the direct anterior (DA) approach is frequently marketed as superior to other approaches, there are concerns about increased risks of intraoperative and early postoperative femoral fracture. Purpose: We sought to assess patient-specific and radiographic risk factors for intraoperative and early postoperative (90-day) periprosthetic femoral fracture (PPFx) following DA approach THA. Methods: We retrospectively reviewed 1107 consecutive, primary, non-cemented DA THAs, performed between April 2009 and January 2015, for intraoperative and early postoperative PPFx. Patients lost to follow-up before 90 days (63), cemented or hybrid THA (52), or early femoral failure for another indication (3) were excluded, yielding 989 hips for analysis. Demographic variables and patient comorbidities were analyzed as risk factors for PPFx. Continuous variables were initially compared with 1-way analysis of variance (ANOVA) and categorical variables with chi-square test. A demographic matched-paired radiographic analysis was performed for femoral stem canal fill and compared using univariate logistic regression. Results: The incidence of perioperative PPFx was 2.02%, including 10 intraoperative and 10 early postoperative fractures. Sustaining a postoperative PPFx was associated with being 70 years old or older with a body mass index (BMI) of less than 25, or with having either osteoporosis or Parkinson disease. Radiographs demonstrated that intraoperative PPFx was associated with stems that filled greater proximally rather than distally. Conclusion: Our cohort study found older age, age over 70 with BMI of less than 25, osteoporosis, and Parkinson disease were associated with increased risk for early postoperative PPFx following DA approach THA. Intraoperative fractures may occur with disproportionate proximal femoral canal fill. Further study can evaluate whether cemented femoral components may mitigate risk in these patient populations.

scholarly journals A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty

Pain Medicine ◽  
2019 ◽  
Vol 21 (7) ◽  
pp. 1474-1481 ◽  
Author(s):  
Mallika Tamboli ◽  
Edward R Mariano ◽  
Kerianne E Gustafson ◽  
Beverly L Briones ◽  
Oluwatobi O Hunter ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Opioid Consumption ◽  
Mean Difference ◽  
Patient Specific ◽  
Prescription Data ◽  
Opioid Dose ◽  
Total Hip ◽  
Institutional Review ◽  
Discharge Protocol

Abstract Objective This retrospective cohort study tested the hypothesis that implementing a multidisciplinary patient-specific discharge protocol for prescribing and tapering opioids after total hip arthroplasty (THA) will decrease the morphine milligram equivalent (MME) dose of opioids prescribed. Methods With institutional review board approval, we analyzed a Perioperative Surgical Home database and prescription data for all primary THA patients three months before (PRE) and three months after (POST) implementation of this new discharge opioid protocol based on patients’ prior 24-hour inpatient opioid consumption. The primary outcome was total opioid dosage in MME prescribed and opioid refills for six weeks after surgery. Secondary outcomes included the number of tablets and MME prescribed at discharge, in-hospital opioid consumption, length of stay, and postoperative complications. Results Forty-nine cases (25 PRE and 24 POST) were included. Total median (10th–90th percentiles) MME for six weeks postoperatively was 900 (57–2082) MME PRE vs 295 (69–741) MME POST (mean difference = 721, 95% confidence interval [CI] = 127–1316, P = 0.007, Mann-Whitney U test). Refill rates did not differ. The median (10th–90th percentiles) initial discharge prescription in MME was 675 (57–1035) PRE vs 180 (18–534) POST (mean difference = 387, 95% CI = 156–618, P = 0.003, Mann-Whitney U test) MME. There were no differences in other outcomes. Conclusions Implementation of a patient-specific prescribing and tapering protocol decreases the mean six-week dosage of opioid prescribed by 63% after THA without increasing the refill rate.

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