Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis
Aims: The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice. Methods: A model of a THA was developed using a 20° lipped liner. K...
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| Format: | Article |
| Language: | English |
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The British Editorial Society of Bone & Joint Surgery
2023-09-01
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| Series: | Bone & Joint Research |
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| Online Access: | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.129.BJR-2022-0471.R1 |
| _version_ | 1827805127704051712 |
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| author | Alessandro Navacchia Joseph Pagkalos Edward T. Davis |
| author_facet | Alessandro Navacchia Joseph Pagkalos Edward T. Davis |
| author_sort | Alessandro Navacchia |
| collection | DOAJ |
| description | Aims: The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice. Methods: A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o’clock). Results: The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o’clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre. Conclusion: The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o’clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning. Cite this article: Bone Joint Res 2023;12(9):570–578. |
| first_indexed | 2024-03-11T21:21:09Z |
| format | Article |
| id | doaj.art-a584a7b7537d488cb6c5a4ac54aeadc1 |
| institution | Directory Open Access Journal |
| issn | 2046-3758 |
| language | English |
| last_indexed | 2024-03-11T21:21:09Z |
| publishDate | 2023-09-01 |
| publisher | The British Editorial Society of Bone & Joint Surgery |
| record_format | Article |
| series | Bone & Joint Research |
| spelling | doaj.art-a584a7b7537d488cb6c5a4ac54aeadc12023-09-28T06:55:48ZengThe British Editorial Society of Bone & Joint SurgeryBone & Joint Research2046-37582023-09-0112957057810.1302/2046-3758.129.BJR-2022-0471.R1Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysisAlessandro Navacchia0https://orcid.org/0000-0002-0375-8779Joseph Pagkalos1https://orcid.org/0000-0002-9890-9831Edward T. Davis2https://orcid.org/0000-0003-2198-9068Smith+Nephew, Pittsburgh, Pennsylvania, USAThe Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UKThe Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UKAims: The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice. Methods: A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o’clock). Results: The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o’clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre. Conclusion: The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o’clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning. Cite this article: Bone Joint Res 2023;12(9):570–578.https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.129.BJR-2022-0471.R1total hip arthroplastylipped linerrange of motionjump distancehipposterior dislocationtotal hip arthroplasties (thas)flexionanterior dislocationposterior approachacetabular componentfemoral headposterior lipsoft-tissue |
| spellingShingle | Alessandro Navacchia Joseph Pagkalos Edward T. Davis Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis Bone & Joint Research total hip arthroplasty lipped liner range of motion jump distance hip posterior dislocation total hip arthroplasties (thas) flexion anterior dislocation posterior approach acetabular component femoral head posterior lip soft-tissue |
| title | Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis |
| title_full | Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis |
| title_fullStr | Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis |
| title_full_unstemmed | Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis |
| title_short | Defining the optimal position of the lipped liner in combination with cup orientation and stem version: a kinematic model analysis |
| title_sort | defining the optimal position of the lipped liner in combination with cup orientation and stem version a kinematic model analysis |
| topic | total hip arthroplasty lipped liner range of motion jump distance hip posterior dislocation total hip arthroplasties (thas) flexion anterior dislocation posterior approach acetabular component femoral head posterior lip soft-tissue |
| url | https://online.boneandjoint.org.uk/doi/epdf/10.1302/2046-3758.129.BJR-2022-0471.R1 |
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