Abstract
Impingement is a major source of dislocation and aseptic loosening in total hip arthroplasty (THA). We compared impingement free range of motion (ROM) using a novel computer navigated femur first approach to conventional THA. In addition, impingement between genders was also explored. In a retrospective analysis of 121 THA patients, subject-specific post-operative ROM was simulated using post-operative 3D-CT data, and compared with the benchmark ROM, essential for activities of daily living. Three parameters were defined to express both implant-to-implant (ITI) and bone-to-bone (BTB) impingement - coverage percentage, third angle, and impingement severity. Although coverage percentage was similar between the navigated and conventional group for both ITI (p = 0.69) and BTB (p = 0.82) impingement, third angle was significantly reduced in the navigation group for both ITI (p = 0.02) and BTB (p = 0.05) impingement. Impingement severity for both ITI (p = 0.01) and BTB (p = 0.05) was significantly decreased in the navigation group compared to the conventional. Impingement severity in men was considerably higher compared to women for both ITI (p = 0.002) and BTB (p = 0.02). Navigation guided femur first THA is able to improve alignment of ROM axis, and consequently, to reduce impingement in THA. Men seem to be more prone to impingement than women.
Highlights
Total hip arthroplasty (THA) is considered as one of the most effective techniques to restore lost manoeuvrability to patients suffering from osteoarthritis (OA), acute trauma and rheumatoid arthritis (RA)[1, 2]
To assess whether a computer navigated femur first approach is more effective with regard to providing an impingement free range of motion in comparison to conventional total hip arthroplasty (THA) as measured by ROM size, ROM alignment and impingement severity of THA patients in a virtual range of motion simulation using post-operative CT scan data
It was observed that the post-operative ROM (PO-ROM) alignment with respect to benchmark ROM (B-ROM) directional axis for BTB impingement as measured by third angle was statistically improved (p = 0.05) in navigated group (M = 15.5°, SD = 8.1°, Fig. 6b) in comparison with the conventional group (M = 18.3°, SD = 7.7°, Fig. 6b))
Summary
Total hip arthroplasty (THA) is considered as one of the most effective techniques to restore lost manoeuvrability to patients suffering from osteoarthritis (OA), acute trauma and rheumatoid arthritis (RA)[1, 2]. Impingement in THA results greater component wear, limited range of movement (ROM) with reduced hip functionalities, and increased pain[8, 9]. An innovative computer-assisted THA operation, which implemented the concept of ‘femur first’/ ‘combined anteversion’ was introduced to overcome the limitations of the traditional THA5, 12 This approach combined several aspects in performing a functional optimisation of the cup position, and extensively addressed ROM while maintaining cup alignment and containment parameters as detailed by Renkawitz, et al.[5]. To assess whether a computer navigated femur first approach is more effective with regard to providing an impingement free range of motion in comparison to conventional THA as measured by ROM size, ROM alignment and impingement severity of THA patients in a virtual range of motion simulation using post-operative CT scan data. To assess whether there are sex specific differences in ROM as measured by ROM size, ROM alignment and impingement severity
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