Weber, Markus and Woerner, Michael L. and Sendtner, Ernst and Voellner, Florian and Grifka, Joachim and Renkawitz, Tobias F. (2016) Even the Intraoperative Knowledge of Femoral Stem Anteversion Cannot Prevent Impingement in Total Hip Arthroplasty. JOURNAL OF ARTHROPLASTY, 31 (11). pp. 2514-2519. ISSN 0883-5403, 1532-8406
Full text not available from this repository.Abstract
Background: In this prospective study of 66 patients undergoing cementless total hip arthroplasty through a minimally invasive anterolateral approach, we evaluated the impact of an intraoperative hybrid combined anteversion technique on postoperative range of motion (ROM). Methods: After navigation of femoral stem anteversion, trial acetabular components were positioned manually, and their position recorded with navigation. Then, final components were implanted with navigation at the goals prescribed by the femur-first impingement detection algorithm. Postoperatively, three-dimensional computed tomographies were performed to determine achieved component position and model impingement-free ROM by virtual hip movement, which was compared with published values necessary for activities of daily living. This model was run a second time with the implants in the position selected by the surgeon rather than the navigation program. In addition, we researched into risk factors for ROM differences between the freehand and navigated cup position. Results: We found a lower flexion of 8.3 degrees (8.8 degrees, P < .001) and lower internal rotation of 9.2 degrees (9.5 degrees, P < .001) for the freehand implanted cups in contrast to a higher extension of 9.8 degrees (11.8 degrees, P < .001) compared with the navigation-guided technique. For activities of daily living, 58.9% (33/56) in the freehand group compared with 85.7% (48/56) in the navigation group showed free flexion (P < .001) and similarly 50.0% (28/56) compared with 76.8% (43/56) free internal rotation (P < .001). Body mass index, incision length, and cup size were identified as independent risk factors for reduced flexion and internal rotation in the freehand group. Conclusion: For implementation of a combined anteversion algorithm, intraoperative alignment guides for accurate cup positioning are required using a minimally invasive anterolateral approach. Obese patients are especially at risk of cup malpositioning. (C) 2016 Elsevier Inc. All rights reserved.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FREE RANGE; MOTION; NAVIGATION; IMPACT; combined anteversion; femur first; impingement; range of motion; total hip arthroplasty |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Orthopädie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 24 Apr 2019 07:16 |
| Last Modified: | 24 Apr 2019 07:16 |
| URI: | https://pred.uni-regensburg.de/id/eprint/4006 |
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