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Computer-assisted versus Manual Alignment in THA: A Probabilistic Approach to Range of Motion

  • Symposium: Papers Presented at the Hip Society Meetings 2008
  • Published:
Clinical Orthopaedics and Related Research

Abstract

Dislocation remains a major complication after THA, and range of motion before impingement is important in joint stability. Variability in implant alignment affects resultant range of motion. We used a probabilistic modeling approach to assess the effects of implant alignment variability based on manual and computer-assisted surgical (CAS) techniques on resultant range of motion after THA. We implemented a contact detection algorithm within a probabilistic analysis framework. The normally distributed alignment variables (mean ± 1 standard deviation) were cup abduction (manual = 45° ± 7.6°, CAS = 45° ± 5.7°), cup anteversion (manual = 20° ± 9.6°, CAS = 20° ± 4.5°), and stem anteversion (manual and CAS = 10° ± 1.5°). The outcomes of the probabilistic analysis were range of motion distributions with 1% and 99% bounds. The upper bounds of motion for manual and CAS alignment were similar because bony impingement was the limiting factor. The lower bounds of range of motion were substantially different depending on the type of surgical alignment; manual alignment produced a smaller range of motion in 3% to 5% of cases. CAS implant alignment produced range of motion values above minimum acceptable levels in all cases simulated.

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Acknowledgments

We thank Clifford W. Colwell, Jr. MD for his assistance with the surgical technique and Oliver Kessler, MD for providing the CAD models.

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Authors and Affiliations

  1. Computational Biomechanics Group, Colorado School of Mines, Golden, CO, USA

    Anthony J. Petrella PhD

  2. Computational Biomechanics Laboratory, University of Denver, Denver, CO, USA

    Joshua Q. Stowe MS, Paul J. Rullkoetter PhD & Peter J. Laz PhD

  3. Scripps Clinic, Shiley Center for Orthopaedic Research and Education at Scripps Clinic, 11025 North Torrey Pines Road, Suite 140, La Jolla, CA, 92037, USA

    Darryl D. D’Lima MD, PhD

Authors
  1. Anthony J. Petrella PhD
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  2. Joshua Q. Stowe MS
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  3. Darryl D. D’Lima MD, PhD
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  4. Paul J. Rullkoetter PhD
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  5. Peter J. Laz PhD
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Corresponding author

Correspondence to Darryl D. D’Lima MD, PhD.

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All authors certify that they have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.

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Petrella, A.J., Stowe, J.Q., D’Lima, D.D. et al. Computer-assisted versus Manual Alignment in THA: A Probabilistic Approach to Range of Motion. Clin Orthop Relat Res 467, 50–55 (2009). https://doi.org/10.1007/s11999-008-0561-4

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  • DOI: https://doi.org/10.1007/s11999-008-0561-4

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