Li Wendy, Leong Anthony, Thompson Matthew, Miller Jessica, McEwan Alistair, Esposito Christina I
The University of Sydney, School of Biomedical Engineering, Sydney, NSW, Australia.
The Orthocentre, Kareena Private Hospital, Sydney, Australia.
J Arthroplasty. 2025 Jul;40(7):1730-1737. doi: 10.1016/j.arth.2025.01.010. Epub 2025 Jan 20.
The ideal anteversion at which the acetabular and femoral components for a total hip arthroplasty (THA) should be implanted is still a subject of debate. An alignment philosophy being explored is restoration of individual constitutional femoral and acetabular anteversion. This study aimed to measure combined anteversion in a healthy hip population and understand the expected phenotypes and ranges for constitutional hip alignment.
Computed tomography scans of 338 healthy hips were analyzed using advanced modeling and analysis software that automatically maps landmarks consistently across all scans. Four distinct methods for measuring the acetabular and femoral versions were employed, each derived from different landmark placements. Acetabular and femoral versions were classified as either normal (10 to 20°), increased (> 20°), or decreased (< 10°), resulting in nine potential hip phenotypes, and the prevalence of each in the healthy population was determined.
Femoral and acetabular version angles varied depending on the number of points used to measure them. There was wide variability in acetabular and femoral anteversion angles, ranging from 6 to 26° acetabular anteversion and from 5° retroversion to 32° femoral anteversion. Only 29% of hips were found to have constitutional combined anteversion between 20 and 40°, with acetabular version between 10° and 20° and femoral version between 10 and 20°.
There is increasing interest in individualized implant alignment for THA, since studies have shown the Lewinnek "safe zone" does not guarantee hip stability. The results found in this study suggest that a single target for implant alignment may not be optimal for recreating a patient's constitutional hip alignment. Further research should consider how changes in combined anteversion during THA implant placement can impact patient outcomes.
全髋关节置换术（THA）中髋臼和股骨组件应植入的理想前倾角度仍是一个有争议的话题。正在探索的一种对线理念是恢复个体固有的股骨和髋臼前倾角度。本研究旨在测量健康髋关节人群的联合前倾角度，并了解固有髋关节对线的预期表型和范围。
使用先进的建模和分析软件对338例健康髋关节的计算机断层扫描进行分析，该软件能在所有扫描中一致地自动标记地标。采用四种不同的方法测量髋臼和股骨的角度，每种方法都基于不同的地标放置。髋臼和股骨角度分为正常（10至20°）、增加（>20°）或减少（<10°），从而产生九种潜在的髋关节表型，并确定每种表型在健康人群中的患病率。
股骨和髋臼角度因用于测量的点数而异。髋臼和股骨前倾角度存在很大差异，髋臼前倾角度范围为6至26°，股骨前倾角度范围为5°后倾至32°前倾。只有29%的髋关节被发现其固有联合前倾角度在20至40°之间，髋臼角度在10°至20°之间，股骨角度在10至20°之间。
由于研究表明Lewinnek“安全区”并不能保证髋关节的稳定性，因此对于THA的个性化植入物对线越来越受到关注。本研究的结果表明，单一的植入物对线目标可能并非重建患者固有髋关节对线的最佳选择。进一步的研究应考虑THA植入物放置过程中联合前倾角度的变化如何影响患者的预后。
