Dataset Information

Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty.

ABSTRACT:

Background

Acetabular osteophytes are common findings during total hip arthroplasty (THA).

Purpose

This study was designed to determine the extent to which osteophytes may limit range of motion (ROM) and in which locations impingement is likely to occur if osteophytes are not removed during surgery.

Methods

Computer-aided design was used to compare ROM of a modern hip implant in four cadaver models with and without 10-mm acetabular rim osteophytes added. A clock face, with 12 o'clock at the superior pole of the right acetabulum, was used to map impingement.

Results

The osteophyte model limited ROM in flexion (101° v. 113°, p?=?0.03), 90° of flexion with internal rotation (16.7° v. 31.6°, p?=?0.01), and external rotation (30.4° v. 49.5°, p?=?0.01). Impingement occurred between 7 and 8 o'clock in external rotation and 1 and 2 o'clock in the other two motions.

Conclusions

Osteophytes in these positions have the greatest impact on ROM and should be removed during THA.

SUBMITTER: Rodriguez-Elizalde S

PROVIDER: S-EPMC3772166 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Publications

Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty.

Rodriguez-Elizalde Sebastian S Yeager Alyssa M AM Ravi Bheeshma B Lipman Joseph D JD Salvati Eduardo A EA Westrich Geoffrey H GH

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20130726 3

<h4>Background</h4>Acetabular osteophytes are common findings during total hip arthroplasty (THA).<h4>Purpose</h4>This study was designed to determine the extent to which osteophytes may limit range of motion (ROM) and in which locations impingement is likely to occur if osteophytes are not removed during surgery.<h4>Methods</h4>Computer-aided design was used to compare ROM of a modern hip implant in four cadaver models with and without 10-mm acetabular rim osteophytes added. A clock face, with ...[more]

PMID: 24426873

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Project description:PurposeTo determine whether inclusion of the acetabular labrum affects the maximum range of motion (ROM) during simulation of the flexion-adduction-internal rotation impingement examination.MethodsThree-dimensional surface reconstructions of the femur, hemi-pelvis, and labrum from computed tomography arthrography images of 19 participants were used to simulate maximum ROM during the flexion-adduction-internal rotation examination. Simulations were conducted for positions between 70° and 110° flexion and 0° and 20° adduction at 10° increments to measure maximum internal rotation and the position of contact between the femur and acetabular rim (bone-to-bone) or the femur and labrum (bone-to-labrum). Internal rotation angles and clock-face position values were compared between the 2 contact scenarios for each position.ResultsThe ROM in the bone-to-labrum contact model was significantly less than that of the bone-to-bone contact model for all evaluated positions (P ≤ .001, except at 110° flexion and 20° adduction, P = .114). The inclusion of the labrum reduced internal rotation by a median [interquartile range] of 18 [15, 25]° while altering the position of contact on the acetabular clock-face by -0:01 [-0:27, 0:16]. The variability in contact location for the bone-to-labrum contact scenario was nearly double that of the bone-to-bone contact scenario, as indicated by the interquartile range.ConclusionsInclusion of the anatomy of the acetabular labrum in collision models used to simulate impingement examinations reduced the internal rotation ROM by approximately 20° and increased variability in the location of contact relative to the acetabular rim.Clinical relevanceWhile standard bone-to-bone contact ROM simulations may be informative with respect to the relative change in ROM based on a surgical intervention (e.g., pre- and post-osteochondroplasty for cam-type femoroacetabular impingement), they may not accurately represent the clinical ROM of the joint or the kinematic position at which damage may occur due to shape mismatch between the femur and acetabulum.

Project description:Purpose To determine the prevalence of 4 different types of acetabular rim ossifications, including partial labral ossification or punctate calcification, true os acetabuli, acetabular rim stress fracture, and complete labral ossification, and to determine whether different types of periacetabular ossifications are linked to demographic or radiological factors. Methods We retrospectively reviewed the medial records of patients presenting for hip-related complaints at 2 sports medicine practices from September 2007 to December 2009. An anteroposterior radiograph of both hips and a lateral radiograph of each hip was obtained for all patients and reviewed for findings of cam and pincer femoroacetabular impingement, degenerative changes (Tönnis grade), and periacetabular calcifications for both hips. These parameters were also evaluated with respect to symptoms, sex, and age. Results Four hundred ninety-one consecutive patients (982 hips) presented to 2 orthopaedic surgeons at 2 centers for “hip”-related complaints. There were 223 males and 268 females (age 39 ± 14 years). The overall prevalence of periacetabular calcifications in hips was 17.6%, with 56.6% of calcifications in the symptomatic hip and 43.4% in the contralateral hip. Four basic patterns of calcification were identified: punctuate calcifications within the labrum (8.0% hips), large rounded calcifications (os acetabuli) (4.2% hip), large fragments with a vertical line of the superior-lateral acetabular rim, consistent with healed or non-healed stress fracture (2.0% hips), and complete ossification of the labrum (3.4% hips). Overall, male sex (P = .002), increased lateral center-edge angle (P = .046), and higher Tönnis grade (P < .001) statistically predicted the presence of periacetabular ossification. Punctate calcifications were more prevalent in males (P = .002). Higher Tönnis grade (P = .029) and increased alpha angle (P = .046) were more prevalent with os acetabuli. Younger age (P = .001), male sex (P = .048), increased alpha angle (P = .012), and increased lateral center-edge angle (P < .001) were more prevalent in acetabular rim fractures. No factors were statistically significant at predicting the presence of an ossified labrum. Conclusions Periacetabular calcifications are not uncommon. Four particular patterns of calcification are identified: punctate labral calcifications (8%), larger rounded calcifications (i.e., os acetabuli) (4.2%), acetabular rim stress fractures (2%), and complete ossification of the labrum (3.4%) for a combined prevalence of 17.6% in patients presenting to an orthopaedic surgeon with “hip”-related complaints. Nearly half were in the asymptomatic hip. Male sex had a higher prevalence of periacetabular calcifications. An increased lateral center edge angle and higher Tönnis grade also had a higher prevalence of periacetabular calcifications. Younger male patients are more likely to have acetabular rim stress fractures. Patients with an increased alpha angle have a higher prevalence of os acetabuli and rim stress fractures. Clinical Relevance This study aims to identify, quantify, and categorize periacetabular calcifications about the hip. Their clinical relationships and relevance have been discussed, but no study has distinctly categorized the various types and their prevalence. This study provides a framework for identification and categorization.

Dataset Information

Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty.

Background

Purpose

Methods

Results

Conclusions

Publications

Computerized virtual surgery demonstrates where acetabular rim osteophytes most reduce range of motion following total hip arthroplasty.

Similar Datasets

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