Computer simulation based on in vivo kinematics of a replaced hip during chair-rising for elucidating target cup and stem positioning with a safety range of hip rotation

  • Kyohei Shiomoto
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Satoshi Hamai
    Correspondence
    Corresponding author at: Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

    Department of Medical-Engineering Collaboration for Healthy Longevity, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Satoru Ikebe
    Affiliations
    Department of Creative Engineering, National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka 802-0985, Japan
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  • Hidehiko Higaki
    Affiliations
    Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
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  • Daisuke Hara
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan

    Department of Artificial Joints and Biomaterials, Faculty of Medical Science, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Hirotaka Gondo
    Affiliations
    Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
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  • Keisuke Komiyama
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Kensei Yoshimoto
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Satoru Harada
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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  • Yasuharu Nakashima
    Affiliations
    Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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      Highlights

      • Optimal cup position to avoid impingement was simulated using in vivo kinematics.
      • The liner-to-neck distance decreased as the internal/external rotation angle was increased.
      • Combined anteversion is significantly smaller due to internal rotation.
      • Cup anteversion is significantly larger due to external rotation.
      • If the stem anteversion is small or large, the adjustment of the stem anteversion must be considered.

      Abstract

      Background
      After total hip arthroplasty, dislocation can occur when a patient unexpectedly assumes internal/external limb positions, even during chair-rising, which is a frequently activity of daily life. Therefore, determining the target cup position to avoid impingement in unexpected limb positions using in vivo data of daily life activities is critical.
      Methods
      A computer simulation was performed on 21 total hip arthroplasty patients using patient-specific component placements and hip kinematics obtained during chair-rising analysis using image-matching techniques. The liner-to-neck distance and impingement were evaluated by simulating the change in internal/external rotation angle at maximum hip flexion/extension from 0 to 90°. The cutoff values of cup anteversion and combined anteversion at 60° of internal/external rotation were determined.
      Findings
      The anterior/posterior liner-to-neck distances were negatively correlated with internal/external rotation angles (r = −0.82 and −0.78, respectively) and decreased by 1.7 and 1.8 mm for every 15° increase, respectively. Three cases (14%) of anterior/posterior impingement were observed at 60° of internal/external rotation angle, respectively. The cutoff values for cup anteversion and combined anteversion to avoid impingement at 60° of internal/external rotation angle were 12°–25°/38°–62°, respectively. The stem anteversion, adjustable by cup anteversion to meet both the target cup anteversion and combined anteversion, was 13°–50°.
      Interpretation
      Simulated unintentional internal or external hip rotation, even during chair-rising, caused impingement and posed a dislocation risk. If the stem anteversion is excessively small or large in meeting the target combined anteversion, adjustments to stem anteversion could be recommended in addition to adjustments in cup anteversion.

      Keywords

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