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What is the tolerated width of periacetabular osteophytes to avoid impingement in cementless THA?: a three-dimensional simulation study.

Accepted version
Peer-reviewed

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Article

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Authors

Kim, Jung-Taek 
Lee, Jusung 
Lee, Young-Kyun 
Ha, Yong-Chan 
Won, Ye-Yeon 

Abstract

BACKGROUNDS: Impingement is a risk factor for instability and prosthetic failure following total hip arthroplasty (THA). If the periacetabular osteophytes are not removed at surgery, impingement could occur between the osteophytes and the femoral stem following THA. However, excessive removal of the osteophytes could lead to bleeding from the bone. The aim of our study, therefore, was to locate the site of the impingement and to determine the width of tolerable osteophytes, which does not induce impingement during activities of daily living (ADL), using a three-dimensional simulation. METHODS: On 35 hip models, virtual THA was performed. The acetabular cups were positioned at 45° abduction and 20° anteversion, and the anteversion of femoral stems was 15°. Circular osteophytes with a 30-mm rim were built around the acetabular cup. Fourteen ADL motions were simulated, and the osteophytes were removed until there was no impingement. A clock face was used to map the location and the width of tolerable osteophytes. RESULTS: The impingement mainly occurred in antero-superior and posterior portions around the acetabular cup. Only 4.2-6.2-mm osteophytes were tolerable at the antero-superior portion (12-3 o'clock) and 6.3-7.2-mm osteophytes at the posterior portion (8-10 o'clock) following a total hip arthroplasty. In antero-inferior and postero-superior portions, over-20-mm osteophytes did not induce any impingement. CONCLUSION: Osteophytes in the antero-superior and posterior portion of the acetabulum should be excised during a THA to avoid impingement of the femur-stem construct on the acetabular osteophytes during ADLs.

Description

Keywords

Arthroplasty, Hip, Impingement, Osteophyte, Simulation

Journal Title

Archives of Orthopaedic and Trauma Surgery

Conference Name

Journal ISSN

1434-3916
1434-3916

Volume Title

138

Publisher

Springer Verlag