Acetabular Inclination as a Function of Hip Center of Rotation While Obtaining Inferior Screw Fixation: A Simulation Model

Abstract

Clinical success of cementless total hip arthroplasty is predicated on proper component position, restoration of biomechanics, and implantation of a mechanically stable construct. In the setting of acetabular bone loss, this target is more difficult to achieve, and elevation of the center of hip rotation may compromise the ability to obtain inferior screw fixation. We used the LifeMOD virtual human modeling simulation software (Smith & Nephew, San Clemente, CA) to determine the relationship between cup inclination and center of rotation position while maintaining the ability to obtain screw fixation within the superior pubic ramus. This simulation demonstrated that for every 5 mm of hip center elevation, cup inclination increased by 5.67 degrees. Based on this data, we recommend the use of a porous acetabular component when the hip center is elevated. This acetabular reconstruction allows for cementation of a liner to address the vertical nature of the cup needed to obtain inferior screw fixation within the superior pubic ramus.

Keywords

revision hip - acetabular reconstruction - acetabular screw fixation

Publication History

Received: 14 February 2022

Accepted: 01 August 2022

Article published online:
31 December 2022

• References

• 1 Kayani B, Konan S, Thakrar RR, Huq SS, Haddad FS. Assuring the long-term total joint arthroplasty: a triad of variables. Bone Joint J 2019; 101-B (1_Supple_A): 11-18
• 2 Houcke JV, Khanduja V, Pattyn C, Audenaert E. The history of biomechanics in total hip arthroplasty. Indian J Orthop 2017; 51 (04) 359-367
• 3 Paprosky W, Sporer S, O'Rourke MR. The treatment of pelvic discontinuity with acetabular cages. Clin Orthop Relat Res 2006; 453 (453) 183-187
• 4 Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg 2013; 21 (03) 128-139
• 5 Little NJ, Busch CA, Gallagher JA, Rorabeck CH, Bourne RB. Acetabular polyethylene wear and acetabular inclination and femoral offset. Clin Orthop Relat Res 2009; 467 (11) 2895-2900
• 6 Dorr LD. Noncemented fixation without screws is better. Orthopedics 2000; 23 (03) 205
• 7 Delp SL, Wixson RL, Komattu AV, Kocmond JH. How superior placement of the joint center in hip arthroplasty affects the abductor muscles. Clin Orthop Relat Res 1996; (328) 137-146
• 8 Nwankwo CD, Ries MD. Do jumbo cups cause hip center elevation in revision THA? A radiographic evaluation. Clin Orthop Relat Res 2014; 472 (09) 2793-2798
• 9 Patel JV, Masonis JL, Bourne RB, Rorabeck CH. The fate of cementless jumbo cups in revision hip arthroplasty. J Arthroplasty 2003; 18 (02) 129-133
• 10 Hasenauer MD, Paprosky WG, Sheth NP. Treatment options for chronic pelvic discontinuity. J Clin Orthop Trauma 2018; 9 (01) 58-62
• 11 Meneghini RM, Stultz AD, Watson JS, Ziemba-Davis M, Buckley CA. Does ischial screw fixation improve mechanical stability in revision total hip arthroplasty?. J Arthroplasty 2010; 25 (07) 1157-1161
• 12 Solomon LB, Abrahams JM, Callary SA, Howie DW. The stability of the porous tantalum components used in revision THA to treat severe acetabular defects: a radiostereometric analysis study. J Bone Joint Surg Am 2018; 100 (22) 1926-1933
• 13 Sheth NP, Melnic CM, Brown N, Sporer SM, Paprosky WG. Two-centre radiological survivorship of acetabular distraction technique for treatment of chronic pelvic discontinuity: mean five-year follow-up. Bone Joint J 2018; 100-B [phone]
• 14 Hugate RR, Dickey ID, Chen Q, Wood CM, Sim FH, Rock MG. Fixed-angle screws vs standard screws in acetabular prosthesis fixation: a cadaveric biomechanical study. J Arthroplasty 2009; 24 (05) 806-814