Contact force path in total hip arthroplasty: effect of cup medialisation in a whole-body simulation

  • Background: Cup medialisation down to the true acetabular floor in total hip arthroplasty with a compensatory femoral offset increase seems to be mechanically advantageous for the abductor muscles due to the relocation of the lever arms (body weight lever arm decreased, abductor lever arm increased). However, limited information is currently available about the effects of this reconstruction type at the head cup interface, compared to an anatomical reconstruction that maintains the natural lever arms. Through a whole-body simulation analysis, we compared medialised versus anatomical reconstruction in THA to analyse the effects on: (1) contact force magnitude at the head cup interface; (2) contact force path in the cup; and (3) abductor activity. Methods: Musculoskeletal simulations were performed to calculate the above-mentioned parameters using inverse dynamics analysis. The differences between the virtually implanted THAs were calculated to compare the medialised versus anatomical reconstruction. Results: Cup medialisation with compensatory femoral offset increase led to: (1) a reduction in contact force magnitude at the head cup interface up to 6.6%; (2) a similar contact force path in the cup in terms of sliding distance and aspect ratio; and (3) a reduction in abductor activity up to 17.2% (gluteus medius). Conclusions: In our opinion, these potential biomechanical gains do not generally justify a fully medialised reconstruction, especially in younger patients that are more likely to undergo revision surgery in their lifetime. Cup medialisation should be performed until sufficient press fit and bony coverage of a properly sized and oriented cup can be achieved.

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Author:Enrico De Pieri, Federica Atzori, Stephen J. Ferguson, Sebastian DendorferORCiD, Michael Leunig, Martin Aepli
Parent Title (English):HIP International
Document Type:Article
Date of first Publication:2020/04/28
Release Date:2020/05/28
Tag:Cup medialisation; femoral offset; hip contact force; total hip anthroplasty; total hip replacement
GND Keyword:Hüftgelenkprothese; Kontaktkraft; Biomechanische Analyse; Simulation
First Page:624
Last Page:631
Institutes:Fakultät Maschinenbau
Regensburg Center of Biomedical Engineering - RCBE
Fakultät Maschinenbau / Labor Biomechanik (LBM)
research focus:Lebenswissenschaften und Ethik
Licence (German):Keine Lizenz - Es gilt das deutsche Urheberrecht: § 53 UrhG