Effects of Acetabular Cup Orientation and Implant Design on Psoas Impingement in Total Hip Arthroplasty
Background: Durable fixation has been demonstrated with use of large (jumbo) cementless cups in revision total hip arthroplasty (THA). However, anterior protrusion of the cup rim may impinge on the iliopsoas tendon and cause groin pain. The purpose of this study was to assess the effect of cup position and implant design on iliopsoas impingement.
Methods: THA was performed on six cadaver hips using oversized (jumbo) acetabular components, 60 to 66mm. A stainless steel cable was inserted into the psoas tendon sheath to identify the location of the psoas muscle. CT scans were performed on each cadaver and imported in an imaging software. The acetabular shells, cables, and pelvi were segmented to create separate solid models of each. The shortest distance between each shell and cable was measured. To determine the influence of cup inclination and anteversion, the inclination (30°/40°/50°) and anteversion (10°/20°/30°) angles were varied in the virtual model for both a hemispheric and offset head center shell design.
Results: The shell to wire distance increased linearly with greater cup anteversion (R2>0.99) while inclination had less effect. The distance was greater for the offset head center cup in comparison to the hemispheric cup. Our results indicate that psoas impingement is related to both cup position and implant geometry.
Conclusions: For an oversized jumbo cup, psoas impingement is reduced by greater anteversion while cup inclination has little effect. An offset head center cup with an anterior recess was helpful in reducing psoas impingement in comparison to a conventional hemispherical geometry.
Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T,Tsuchiya H. Risk Factors and Cup Protrusion Thresholds for Symptomatic Iliopsoas Impingement After Total Hip Arthroplasty: A Retrospective Case-Control Study. J Arthroplasty 2018; 33: 3288-3296.
Odri GA, Padiolleau GB, Gouin FT. Oversized Cups as a Major Risk Factor of Postoperative Pain After Total Hip Arthroplasty. J Arthroplasty 2014; 29: 753-756.
Henderson RA, Lachiewicz PF. Groin pain after replacement of the hip: aetiology, evaluation and treatment. J Bone Joint Surg 2012; 94B:145 -151.
Lachiewicz PF, Kauk JR. Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg 2009;17:337-344.
Nunley RM, Wilson JM, Gilula L, Clohisy JC, Barrack RL, Maloney WJ. Iliopsoas bursa injections can be beneficial for pain after total hip arthroplasty. Clin Orthop Relat Res 2010;468:519-526.
Chalmers BP, Sculco PK, Sierra RJ, Trousdale RT, Berry DJ. Iliopsoas Impingement After Primary Total Hip Arthroplasty: Operative and Nonoperative Treatment Outcomes. J Bone Joint Surg, 99-A, 557-564, 2017.
O'Connor MI. Use of an anatomical acetabular component for treatment of iliopsoas impingement. J Arthroplasty 2011; 26: 1570 e13-1570e15.
Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR.Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg 1978; 60-A: 217-220.
Abdel MP, von Roth P, Jennings MT, Hanssen AD, Pagnano MW. What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position. Clin Orthop Relat Res. 2016; 474:386-391.
DelSole EM, Vigdorchik JM, Schwarzkopf R, MD, Errico TJ, Buckland AJ. Total Hip Arthroplasty in the Spinal Deformity Population: Does Degree of Sagittal Deformity Affect Rates of Safe Zone Placement, Instability, or Revision? J Arthroplasty 2017; 32: 1910 -1917.
Zumbrunn T, Patel R, Duffy MP, Rubash HE, Malchau H, Freiberg AA. Muratoglu OK, Varadarajan KM. Cadaver-Specific Models for Finite-Element Analysis of Iliopsoas Impingement in Dual-Mobility Hip Implants. J Arthroplasty 2018; 11: 3574-3580.
Khlopas A, Chughtai M, Elmallah RK, Hip-Flores D, Malkani AL, Harwin SF, Mont MA, Ries MD. Novel Acetabular Cup for Revision THA Improves Hip Center of Rotation: A Radiographic Evaluation. Clin Orthop Relat Res 2018; 476: 315-322.
Faizan A, Black BJ, Fay BD, Heffernan CD, Ries MD. Comparison of Head Center Position and Screw Fixation Options Between a Jumbo Cup and an Offset Center of Rotation Cup in Revision Total Hip Arthroplasty: A Computer Simulation Study. J Arthroplasty 2016; 31:307-311.
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: 128-139.
von Roth P, Abdel MP, Harmsen WS, Berry DJ. Uncemented jumbo cups for revision total hip arthroplasty: a concise follow-up, at a mean of twenty years, of a previous report. 15. J Bone Joint Surg 2015; 97-A: 284-287.
Lachiewicz PF, Soileau ES. Fixation, survival, and dislocation of jumbo acetabular components in revision hip arthroplasty. J Bone Joint Surg 2013; 95-A: 543-548.
Whaley AL, Berry DJ, Harmsen WS
Extra-Large Uncemented Hemispherical Acetabular Components for Revision Total Hip Arthroplasty. J Bone Joint Surg 2001; 83-A: 1352-1357.
Langston J, Pierrepont J, Gu Y, Shimmin A. Risk factors for increased sagittal pelvic motion causing unfavourable orientation of the acetabular component in patients undergoing total hip arthroplasty. Bone Joint J 2018; 100-B: 845-852.
Esposito CI, Carroll KM, Sculco PK, Padgett DE, Jerabek SA, Mayman DJ. Total Hip Arthroplasty Patients With Fixed Spinopelvic Alignment Are at Higher Risk of Hip Dislocation. J Arthroplasty 2018; 33: 1449-1454.
Neri T, Philippot R, Farizon F, Boyer B. Results of primary total hip replacement with first generation Bousquet dual mobility socket with more than twenty five years follow up. About a series of two hundred and twelve hips. Int Orthop 2017; 41:557-561.
Boyer B, Philippot R, Geringer J, Farizon F.Primary total hip arthroplasty with dual mobility socket to prevent dislocation: a 22-year follow-up of 240 hips. Int Orthop 2012; 36: 511-518.
Whitehouse MR, Masri BA, Duncan CP, Garbuz DS. Continued good results with modular trabecular metal augments for acetabular defects in hip arthroplasty at 7 to 11 years. Clin Orthop Relat Res 2015; 473:521-527.
Copyright (c) 2019 Michael Ries, Ahmad Faizan, Jingwei Zhang, Scholl Scholl
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.