Computer-assisted versus Manual Alignment in THA: A Probabilistic Approach to Range of Motion

Dislocation remains a major complication after THA, and range of motion before impingement is important in joint stability. Variability in implant alignment affects resultant range of motion. We used a probabilistic modeling approach to assess the effects of implant alignment variability based on manual and computer-assisted surgical (CAS) techniques on resultant range of motion after THA. We implemented a contact detection algorithm within a probabilistic analysis framework. The normally distributed alignment variables (mean ± 1 standard deviation) were cup abduction (manual = 45° ± 7.6°, CAS = 45° ± 5.7°), cup anteversion (manual = 20° ± 9.6°, CAS = 20° ± 4.5°), and stem anteversion (manual and CAS = 10° ± 1.5°). The outcomes of the probabilistic analysis were range of motion distributions with 1% and 99% bounds. The upper bounds of motion for manual and CAS alignment were similar because bony impingement was the limiting factor. The lower bounds of range of motion were substantially different depending on the type of surgical alignment; manual alignment produced a smaller range of motion in 3% to 5% of cases. CAS implant alignment produced range of motion values above minimum acceptable levels in all cases simulated.

[1]  A. Duquennoy,et al.  CAUSES OF DISLOCATION OF TOTAL HIP ARTHROPLASTY , 1994 .

[2]  K. Widmer,et al.  The impact of the CCD-angle on range of motion and cup positioning in total hip arthroplasty. , 2005, Clinical biomechanics.

[3]  W H Harris,et al.  Advances in surgical technique for total hip replacement: without and with osteotomy of the greater trochanter. , 1980, Clinical orthopaedics and related research.

[4]  B. Jaramaz,et al.  Computer Assisted Measurement of Cup Placement in Total Hip Replacement , 1998, Clinical orthopaedics and related research.

[5]  Hartmut Witte,et al.  ISB recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion--part I: ankle, hip, and spine. International Society of Biomechanics. , 2002, Journal of biomechanics.

[6]  Daniel Kluess,et al.  Influence of femoral head size on impingement, dislocation and stress distribution in total hip replacement. , 2007, Medical engineering & physics.

[7]  M. Müller Total hip prostheses. , 1970, Clinical orthopaedics and related research.

[8]  A. Wines,et al.  Computed tomography measurement of the accuracy of component version in total hip arthroplasty. , 2006, The Journal of arthroplasty.

[9]  A. Cotten,et al.  Causes of dislocation of total hip arthroplasty. CT study of component alignment. , 1994, The Journal of bone and joint surgery. British volume.

[10]  B F Morrey,et al.  Dislocations after total hip arthroplasty. , 1982, The Journal of bone and joint surgery. American volume.

[11]  Richard E. White,et al.  Effect of Posterior Capsular Repair on Early Dislocation in Primary Total Hip Replacement , 2001, Clinical orthopaedics and related research.

[12]  Y. Minoda,et al.  Acetabular Component Orientation in 834 Total Hip Arthroplasties Using a Manual Technique , 2006, Clinical orthopaedics and related research.

[13]  B. Zurfluh,et al.  Compliant positioning of total hip components for optimal range of motion , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  Fumihiro Yoshimine,et al.  The safe-zones for combined cup and neck anteversions that fulfill the essential range of motion and their optimum combination in total hip replacements. , 2006, Journal of biomechanics.

[15]  D. McCollum,et al.  Dislocation after total hip arthroplasty. Causes and prevention. , 1990, Clinical orthopaedics and related research.

[16]  John J Callaghan,et al.  Kinematics, kinetics, and finite element analysis of commonplace maneuvers at risk for total hip dislocation. , 2003, Journal of biomechanics.

[17]  D. D’Lima,et al.  The Effect of the Orientation of the Acetabular and Femoral Components on the Range of Motion of the Hip at Different Head-Neck Ratios* , 2000, The Journal of bone and joint surgery. American volume.

[18]  Stephen H. D. Jackson INT CONGR SER , 2001 .

[19]  J. Lewis,et al.  Dislocations after total hip-replacement arthroplasties. , 1978, The Journal of bone and joint surgery. American volume.

[20]  Brigitte M Jolles,et al.  Computer-assisted Cup Placement Techniques in Total Hip Arthroplasty Improve Accuracy of Placement , 2004, Clinical orthopaedics and related research.

[21]  Paul J. Rullkoetter,et al.  Finite element-based probabilistic analysis tool for orthopaedic applications , 2007, Comput. Methods Programs Biomed..

[22]  Shantanu Patil,et al.  Bony impingement affects range of motion after total hip arthroplasty: A subject‐specific approach , 2008, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[23]  P. Genoud,et al.  Accuracy of computer-assisted cup placement in total hip arthroplasty , 2001, CARS.

[24]  R S Turner,et al.  Postoperative total hip prosthetic femoral head dislocations. Incidence, etiologic factors, and management. , 1994, Clinical orthopaedics and related research.

[25]  L.-j. Yuan,et al.  Dislocation after total hip arthroplasty , 1999, Archives of Orthopaedic and Trauma Surgery.

[26]  J. Argenson,et al.  Validation and usefulness of a computer-assisted cup-positioning system in total hip arthroplasty. A prospective, randomized, controlled study. , 2007, The Journal of bone and joint surgery. American volume.

[27]  Achintya Haldar,et al.  Probability, Reliability and Statistical Methods in Engineering Design (Haldar, Mahadevan) , 1999 .

[28]  Lawrence D. Dorr,et al.  Causes of and Treatment Protocol for Instability of Total Hip Replacement , 1998, Clinical orthopaedics and related research.

[29]  Fumihiro Yoshimine,et al.  A mathematical formula to calculate the theoretical range of motion for total hip replacement. , 2002, Journal of biomechanics.

[30]  Branislav Jaramaz,et al.  Three-dimensional planning and virtual radiographs in revision total hip arthroplasty for instability. , 2006, Clinical orthopaedics and related research.

[31]  R. Poss,et al.  Dislocation in total hip arthroplasties. , 1980, Clinical orthopaedics and related research.

[32]  B F Morrey,et al.  Operative correction of an unstable total hip arthroplasty. , 1992, The Journal of bone and joint surgery. American volume.

[33]  David A. Simon,et al.  Range of motion after total hip arthroplasty: experimental verification of the analytical simulator , 1997, CVRMed.

[34]  J. Grifka,et al.  Greater accuracy in positioning of the acetabular cup by using an image-free navigation system , 2005, International Orthopaedics.

[35]  H. Fredin,et al.  Dislocations and the Femoral Head Size in Primary Total Hip Arthroplasty , 1996, Clinical orthopaedics and related research.

[36]  Müller Me Total hip prostheses. , 1970 .

[37]  T. Cruse,et al.  Advanced probabilistic structural analysis method for implicit performance functions , 1990 .

[38]  B F Morrey,et al.  Instability after total hip arthroplasty. , 1992, The Orthopedic clinics of North America.

[39]  H. Amstutz,et al.  Tripolar hip replacement for recurrent prosthetic dislocation. , 1994, Clinical orthopaedics and related research.

[40]  S Van Sint Jan,et al.  Registration of 6-DOFs electrogoniometry and CT medical imaging for 3D joint modeling. , 2002, Journal of biomechanics.

[41]  J. Olsen,et al.  Causes and Prevention , 1991, Scandinavian journal of social medicine.

[42]  Philip C. Noble,et al.  The Effect of Femoral Component Head Size on Posterior Dislocation of the Artificial Hip Joint* , 2000, The Journal of bone and joint surgery. American volume.