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Review
. 2007 Aug;31 Suppl 1(Suppl 1):S29-33.
doi: 10.1007/s00264-007-0429-3.

Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty

Affiliations
Review

Containment versus impingement: finding a compromise for cup placement in total hip arthroplasty

K-H Widmer. Int Orthop. 2007 Aug.

Abstract

Recommendations for cup containment and impingement may provide conflicting directions for component orientation in total hip arthroplasty. For optimal containment, the cup is positioned with respect to the acetabular bone, resulting in coincidence of the rim of the cup and the acetabulum. This results in good coverage and symmetric load transfer, leading to good long-term stability, but occasionally necessitates more abduction of the cup than that recommended by the safe zone. On the other hand, placement of the cup for an optimal range of motion would lead to only partial containment, with a higher risk of component loosening and revision. The most effective compromise is to use a prosthesis that has a large safe zone, realised by a high head-to-neck ratio, and orienting the cup such that a good containment is achieved and the safe zone is respected. Computer navigation or smart aiming devices may help to find the best relative orientation.

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Figures

Fig. 1
Fig. 1
Most of the load is transferred at these three distinct areas, where the acetabular bone is supported by the iliac, pubic and ischial bone (three-spot support, left acetabulum)
Fig. 2
Fig. 2
Seating the cup beyond the cortical rim of the acetabulum will put its osseointegration at risk. Cortical rim contact of the cup is necessary for primary stability and secure osseointegration
Fig. 3
Fig. 3
The safe zone for cup orientation increases with increased head-to-neck ratio, providing more room for error
Fig. 4
Fig. 4
Shape and position of the safe zone is dependent on the neck-to-shaft angle of the stem
Fig. 5
Fig. 5
Secure fixation is achieved by precise reaming of the acetabular bone, even in dysplastic pelvises. Hip biomechanics is restored on the right side after distraction (distance = 8.5 cm)

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References

    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '1549338', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/1549338/'}]}
    2. Elke R, Marugg S (1992) Transmission of force to the trabecular structures of the proximal end of the femur (in German). Orthopäde 21:51–56 - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '9547812', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/9547812/'}]}
    2. Laursen JO, Petersen B, Mossing NB (1998) The Richards Series 2 total hip prosthesis: a 13-year study and radiographic evaluation. Orthopedics 21:277–282 - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '641088', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/641088/'}]}
    2. Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmermann JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 60(2):217–220 - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'PubMed', 'value': '1729002', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/1729002/'}]}
    2. Morscher EW (1992) Current status of acetabular fixation in primary total hip arthroplasty. Clin Orthop Relat Res 274:172–193 - PubMed
    1. {'text': '', 'ref_index': 1, 'ids': [{'type': 'DOI', 'value': '10.1016/S0883-5403(00)91337-8', 'is_inner': False, 'url': 'https://doi.org/10.1016/s0883-5403(00)91337-8'}, {'type': 'PubMed', 'value': '10654469', 'is_inner': True, 'url': 'https://pubmed.ncbi.nlm.nih.gov/10654469/'}]}
    2. Massin P, Geais L, Astoin E, Simondi M, Lavaste F (2000) The anatomic basis for the concept of lateralized femoral stems: a frontal plane radiographic study of the proximal femur. J Arthroplasty 15:93–101 - PubMed