Shozen Hideki, Shoji Takeshi, Ueki Shinichi, Kaneta Hiroki, Kozuma Yosuke, Morita Hiroyuki, Adachi Nobuo
Department of Orthopedic Surgery, Hiroshima University Hospital Graduate School of Biomedical and Health Sciences, Hiroshima City, Hiroshima Prefecture, Japan.
Department of Artificial Joints and Biomaterials, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima City, Hiroshima Prefecture, Japan.
Clin Biomech (Bristol). 2025 Feb;122:106422. doi: 10.1016/j.clinbiomech.2024.106422. Epub 2024 Dec 18.
Total hip arthroplasty is the preferred treatment for advanced hip osteoarthritis, yet complications like hip dislocation (0.2 %-10 %) persist due to factors such as implant design, positioning, surgical technique, and patient-specific conditions. Impingement between prosthetic components or the acetabulum and proximal femur is a primary cause of instability.
A retrospective analysis of 120 patients (130 hips) undergoing total hip arthroplasty at XX Hospital (2011-2023) categorized patients by lateral center-edge angle: developmental dysplasia of the hip, borderline developmental dysplasia of the hip, and normal hip. ct imaging facilitated virtual 3D bone models for motion analysis, excluding cases with prior hip surgery or spinal fusion. Statistical analyses utilized the Mann-Whitney U test and one-way ANOVA.
The developmental dysplasia of the hip group showed the highest posterior impingement frequency, significantly affecting range of motion in flexion, adduction, and external rotation compared to borderline developmental dysplasia of the hip and normal hip groups. Variations in femoral neck anteversion, lesser trochanter version, and ischiofemoral space were notable. Posterior impingement commonly occurred between the lesser trochanter and ischial tuberosity.
Posterior bony impingement emerged as a predominant factor reducing range of motion and increasing dislocation risk, particularly in developmental dysplasia of the hip patients, challenging the conventional "safe zone" for implant positioning. Personalized surgical strategies tailored to individual bone morphology are crucial for enhancing total hip arthroplasty outcomes and minimizing complications, although limitations include the exclusion of soft tissue influences and focusing solely on range of motion until impingement occurs.
全髋关节置换术是晚期髋关节骨关节炎的首选治疗方法，但由于植入物设计、定位、手术技术和患者特定情况等因素，髋关节脱位等并发症（0.2%-10%）仍然存在。假体部件之间或髋臼与股骨近端之间的撞击是不稳定的主要原因。
对XX医院（2011-2023年）接受全髋关节置换术的120例患者（130髋）进行回顾性分析，根据外侧中心边缘角对患者进行分类：髋关节发育不良、临界髋关节发育不良和正常髋关节。CT成像有助于创建虚拟3D骨模型进行运动分析，排除既往有髋关节手术或脊柱融合病史的病例。统计分析采用Mann-Whitney U检验和单因素方差分析。
髋关节发育不良组的后方撞击频率最高，与临界髋关节发育不良组和正常髋关节组相比，显著影响屈曲、内收和外旋的活动范围。股骨颈前倾角、小转子角度和坐骨股骨间隙存在明显差异。后方撞击常见于小转子与坐骨结节之间。
后方骨撞击是减少活动范围和增加脱位风险的主要因素，尤其是在髋关节发育不良患者中，这对植入物定位的传统“安全区”提出了挑战。根据个体骨形态制定个性化的手术策略对于提高全髋关节置换术的疗效和减少并发症至关重要，尽管局限性包括排除软组织影响以及仅关注撞击发生前的活动范围。
