PubMed · 15718914
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Carl L Stanitski. The pseudoacetabulum.. https://doi.org/10.1097/01.bpo.0000154226.77609.d9
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Reduction of the range of motion (ROM) until prosthetic impingement of a total hip replacement may lead to frequent impingement, subluxation and dislocation especially for patients with good hip movement. The ROM until prosthetic impingement can be calculated using the technical ROM (theta) and the cup and neck positions by a previously created mathematical formula. A larger (theta) with proper cup and neck positions results in a larger ROM. However there was only one paper written in English, which revealed the optimum theoretical combination of cup and neck anteversions. ROM of more than 110 degrees flexion, 30 degrees internal-rotation at 90 degrees flexion, 30 degrees extension and 40 degrees external-rotation were defined as the criteria for essential ROM for ADL. The safe-zones for combined cup anteversion (betaanat) and neck anteversion (b) were defined as the areas that fulfill all the criteria of ROM without prosthetic impingement. The safe-zones were created for 35 degrees , 45 degrees and 55 degrees cup abductions (alpha) and for 120 degrees and 135 degrees (theta). The safe-zones for combined (betaanat) and (b) were much larger for a 135 degrees (theta) than a 120 degrees (theta). Their safe-zones showed that (b) should be reduced if (betaanat) is increased and choosing a lower (alpha) requires that the sum of (betaanat) and (b) should be higher and vice versa. A (theta) of more than 135 degrees is recommended as it further increases the size of the safe-zone and provides a larger ROM, and the optimum values of combined cup and neck anteversions can be estimated by the formula: (alpha) + (betaanat) + 0.77(b) = 84.3.
A computational model was developed to identify the sites of third body particle embedment in a total hip acetabular component surface that are most problematic in terms of roughening the overpassing regions of the femoral head counterface, leading in turn to most severely accelerated polyethylene wear. The analytical approach used was to calculate loci of acetabular sites that, during the gait cycle, overpass previously documented regions of kinetically most critical femoral head roughening. Instantaneous local contact stress and sliding distance were postulated as factors contributing to the severity of the femoral head scratching/roughening which would be expected, due to otherwise-similar particles embedded along each such acetabular overpass locus. The computational results showed that the location of debris embedment was a potent determinant of the amount of polyethylene wear acceleration expected. The data also showed that the supero-lateral aspect of the acetabular cup is consistently and by far the most problematic area for third body particle embedment.
The tensile properties of the human acetabular labrum were investigated using a uniaxial tension testing apparatus. The superior quadrant of the acetabular labrum was harvested from patients who underwent hip surgery. The obtained labra were sliced and shaped into rectangles for measuring uniaxial tension. We hypothesized that several characteristics such as gender, age, degeneration due to primary ailment, and the severity of the acetabular dysplasia would influence the tensile properties of the labrum. Antero-posterior radiographs of the pelvis have been used to evaluate the severity of the acetabular dysplasia and to diagnose the developmental dysplasia of the hip joint (DDH) clinically. Thus, we investigated the correlation between each of two representative radiological measurements-the CE angle and the Sharp angle-and tensile properties to assess the influence of the severity of the acetabular dysplasia. The tensile stress-strain curves for the labrum assumed a sigmoid shape. The mean tensile stress at failure for all specimens was 8.8+/-4.1 MPa. The mean strain at failure for all specimens was 48.5+/-10.4%. The mean tensile modulus was 66.4+/-42.2 MPa. Mean tensile stress at failure for specimens from males was greater than that of specimens from females. A significant difference was found in the maximum stress at failure among the three diagnosis-based groups: the other group withstood the highest stress before failure, whereas the osteoarthritis (OA) group withstood the lowest. No significant correlations with age or radiological characteristics were found for tensile stress, strain at failure, or tensile modulus. Our results suggest that labra obtained from male patients have stronger tensile stress than those from female patients, and that degenerative changes may influence the properties of the acetabular labrum.