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Published in:

01-02-2017 | Original Paper

Soft tissue restricts impingement-free mobility in total hip arthroplasty

Authors: Michael Woerner, Markus Weber, Ernst Sendtner, Robert Springorum, Michael Worlicek, Benjamin Craiovan, Joachim Grifka, Tobias Renkawitz

Published in: International Orthopaedics | Issue 2/2017

Abstract

Purpose

Impingement is a major source for decreased range of motion (ROM) and dislocation in total hip arthroplasty (THA). In the current study we analyzed the impact of soft tissue impingement on ROM compared to bony and/or prosthetic impingement.

Methods

In the course of a prospective clinical trial 54 patients underwent cementless total hip arthroplasty in the lateral decubitus position using imageless navigation. The navigation device enabled intra-operative ROM measurements indicating soft tissue impingement. Post-operatively, all patients received postoperative 3D-CT. Absolute ROM without bony and/or prosthetic impingement was calculated with the help of a collision-detection-algorithm.

Results

Due to soft tissue impingement we found a reduced ROM of over 20° (p < 0.001) compared to bony and/or prosthetic impingement regarding flexion, extension, abduction and adduction and of over 10° regarding external rotation (p < 0.001). In contrast, soft tissue impingement showed less impact on internal rotation in 90° of flexion (p = 0.76). Multivariate analysis showed an association between BMI and flexion, whereas all other ROM directions were independent of BMI.

Conclusions

Soft tissue has a major impact on impingement-free ROM after THA. For the majority of movements, soft tissue restrictions are more important than bony and prosthetic impingement. Future models of patient individual joint replacement including pre-operative (CT) planning and intra-operative navigation should include algorithms additionally accounting for soft tissue impingement.

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Title: Soft tissue restricts impingement-free mobility in total hip arthroplasty
Authors: Michael Woerner
Markus Weber
Ernst Sendtner
Robert Springorum
Michael Worlicek
Benjamin Craiovan
Joachim Grifka
Tobias Renkawitz
Publication date: 01-02-2017
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2017
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3216-1

At a glance: The STEP trials

Springer Medicine

Soft tissue restricts impingement-free mobility in total hip arthroplasty

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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