Low femoral antetorsion as a risk factor for bony impingement after bipolar hemiarthroplasty

Journal of Orthopaedic Surgery and Research

Mitsuo Ochi²  Susumu Hachisuka²  Soutarou Izumi²  Takuma Yamasaki²  Yuji Yasunaga¹  Takeshi Shoji² 

[1] Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3, Taguchi, Saijou-town, East Hiroshima, Hiroshima Prefecture, Japan;Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku 734-8551, Hiroshima, Japan

关键词: Impingement pattern;    Dislocation;    Bony impingement;    Femoral antetorsion;    Three-dimensional motion analysis;    Bipolar hemiarthroplasty;   

Others  :  1219207
DOI  :  10.1186/s13018-015-0248-y

 received in 2015-01-09, accepted in 2015-05-02,  发布年份 2015

【 摘 要 】

Introduction

Reports of dislocation after bipolar hemiarthroplasty (BHA) abound in literature, and several studies have mentioned the factors that are associated with an increased risk of dislocation. However, there is no report detailing the pattern of impingement in BHA and how femoral antetorsion can affect the range of motion (ROM) after BHA.

Purpose

The purpose of this study was to evaluate the pattern of impingement in BHA and whether femoral antetorsion affects the ROM after BHA using three-dimensional (3D) dynamic motion analysis.

Methods

Using the computed tomography (CT) data of 60 patients (60 hips), including 31 men and 29 women who underwent BHA for the treatment of idiopathic osteonecrosis (ION) of the femoral head, we calculated the antetorsion of the femoral neck, ROM of flexion (Flex), internal rotation (Int-R), and external rotation (Ext-R) using a CT-based 3D simulation software. We evaluated the pattern of impingement and the relationship between femoral antetorsion and ROM in BHA. As for the implant position in the 3D simulation software, the anteversion of the femoral implant was set to be the same as the natural antetorsion of the femoral neck and neck length was set to be the standard neck in all cases.

Results

This study revealed the mechanism of impingement in BHA: (1) bone to bone impingement and (2) implant to bone impingement. We found a significant decrease in the ROM of Flex and Int-R inversely proportional to the femoral antetorsion. In patients with lower femoral antetorsion, the ROM of Flex and Int-R decreased due to bony impingement (the anterior great trochanteric region of the femur impinges on the anteroinferior edge of the anteroinferior iliac spine). Whereas, high anteversion of the femoral implant may decrease the ROM of Ext-R; however, our results also showed that even the lowest ROM of Ext-R with 10° hip extension was over 40°.

Conclusions

We demonstrated that lower femoral antetorsion substantially affects the ROM of Flex and Int-R due to bony impingement. For these patients, there should be consideration given to retaining femoral “anterior offset” in BHA.

【 授权许可】

   
2015 Shoji et al.

【 图 表 】

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