Shiomoto Kyohei, Hamai Satoshi, Ikebe Satoru, Higaki Hidehiko, Hara Daisuke, Gondo Hirotaka, Komiyama Keisuke, Yoshimoto Kensei, Harada Satoru, Nakashima Yasuharu
Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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.
Clin Biomech (Bristol). 2022 Jan;91:105537. doi: 10.1016/j.clinbiomech.2021.105537. Epub 2021 Nov 20.
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.
背景 全髋关节置换术后，患者即使在从椅子上起身（这是日常生活中常见的活动）时意外采取内收/外展肢体姿势，也可能发生脱位。因此，利用日常生活活动的体内数据确定目标髋臼位置以避免在意外肢体姿势下发生撞击至关重要。方法 对21例全髋关节置换患者进行计算机模拟，使用患者特异性的假体组件放置以及通过图像匹配技术在从椅子上起身分析过程中获得的髋关节运动学数据。通过模拟在最大髋关节屈伸时从0°到90°的内旋/外旋角度变化来评估衬垫与股骨颈的距离和撞击情况。确定了在内旋/外旋60°时髋臼前倾角和联合前倾角的临界值。结果 前后衬垫与股骨颈的距离与内旋/外旋角度呈负相关（分别为r = -0.82和-0.78），每增加15°分别减少1.7和1.8毫米。在内旋/外旋60°时分别观察到3例（14%）前后撞击。避免在内旋/外旋60°时发生撞击的髋臼前倾角和联合前倾角的临界值分别为12° - 25°/38° - 62°。为满足目标髋臼前倾角和联合前倾角而可通过髋臼前倾角调整的股骨柄前倾角为13° - 50°。解读 即使在从椅子上起身过程中模拟的意外髋关节内旋或外旋也会导致撞击并带来脱位风险。如果在满足目标联合前倾角时股骨柄前倾角过小或过大，除了调整髋臼前倾角外，建议调整股骨柄前倾角。
