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. 2022 Apr 10;17(1):226.
doi: 10.1186/s13018-022-03112-6.

Optimal combined anteversion range for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study

Ryo Hidaka  1 , Kenta Matsuda  2 , Masaki Nakamura  3 , Shigeru Nakamura  4 , Hirotaka Kawano  2
Affiliations

Optimal combined anteversion range for obtaining a wider range of motion without prosthetic impingement after total hip arthroplasty: a three-dimensional analysis study

Ryo Hidaka et al. J Orthop Surg Res. .

Abstract

Background: Obtaining a larger theoretical range of motion (ROM) is crucial to avoid prosthetic impingement after total hip arthroplasty (THA); however, no reports have examined the permissible range values of combined anteversion (CA) satisfying targeted ROM without prosthetic impingement. This retrospective study aimed to evaluate the possible postoperative CA extent that would allow meeting target ROM criteria according to Yoshimine's theory using computed tomography (CT)-based three-dimensional motion analysis after THA.

Methods: This study included 114 patients (133 hips) who underwent cementless primary THA using a CT-based navigation system and implants (oscillation angle ≥ 135°). Implant positions were determined using Yoshimine's CA formula. Postoperative evaluation was conducted using a three-dimensional templating software for CT data. The postoperative Yoshimine's and Widmer's CA was calculated, and the difference between the target and postoperative values was defined as the error of Yoshimine's CA and Widmer's CA. Prosthetic ROM was assessed by Yoshimine's stringent criteria for activities of daily living. Based on fulfilling these criteria, all patients were divided into the ROM (+) and ROM (-) groups. Evaluation items were compared between the two groups.

Results: There were 111 and 22 hips in the ROM (+) and ROM (-) groups, respectively. A significant difference was noted in the absolute error of Yoshimine's and Widmer's CA between the two groups. Using receiver operating characteristic analysis, threshold values of 6.0 (higher values indicate greater disability; sensitivity 90.9%, specificity 72.1%) for the absolute Yoshimine's CA difference (area under the curve [AUC] 0.87, P < 0.01) and 6.9 (higher values indicate greater disability; sensitivity 68.2%, specificity 88.3%) for the absolute Widmer's CA difference (AUC 0.83, P < 0.01) were predictors in the ROM (-) group.

Conclusions: The target range of Yoshimine's CA (90.8° ± 6.0°) and Widmer's CA values (37.3° ± 6.9°) was crucial in implant orientation for obtaining theoretical ROM without prosthetic impingement after THA.

Keywords: Activities of daily living; Arthroplasty; Hip prosthesis; Joint dislocation; Polyethylene; X-ray computed tomography.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection flowchart
Fig. 2
Fig. 2
Implant orientations are measured by superimposing the CAD models of the implants on postoperative CT images using Zed Hip. Yoshimine’s CA and Widmer’s CA were calculated from the implant orientation measurements. CAD, computer-aided design; CA combined anteversion
Fig. 3
Fig. 3
ROC curve on the predictive value of absolute error of Yoshimine’s CA in the ROM (−) group ROC, receiver operating characteristic; CA combined anteversion
Fig. 4
Fig. 4
ROC curve on the predictive value of absolute error of Widmer’s CA in the ROM (−) group ROC, receiver operating characteristic; CA combined anteversion
See this image and copyright information in PMC

References

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