Does acetabular retroversion affect range of motion after total hip arthroplasty?
BACKGROUND
Increasingly, acetabular retroversion is recognized in patients undergoing hip arthroplasty. Although prosthetic component positioning is not determined solely by native acetabular anatomy, acetabular retroversion presents a dilemma for component positioning if the surgeon implants the device in the anatomic position.


OBJECTIVE
We asked (1) whether there is a difference in ROM between surface replacement arthroplasty (SRA) and THA in the retroverted acetabulum, and (2) does increased femoral anteversion improve ROM in the retroverted acetabulum?


METHODS
Using a motion analysis tracking system, we determined the ROM of eight cadaveric hips and then created virtual CT-reconstructed bone models of each specimen. ROM was determined with THA and SRA systems virtually implanted with (1) the acetabular component placed in 45° abduction and matching the acetabular anteversion (average 23° ± 4°); (2) virtually retroverting the bony acetabulum 10°; and (3) after anteverting the THA femoral stem 10°.


RESULTS
SRA resulted in ROM deficiencies in four of six maneuvers, averaging 25% to 29% in the normal and retroverted acetabular positions. THA restored ROM in all six positions in the normal acetabulum and in four of the six retroverted acetabula. The two deficient positions averaged 5% deficiency. THA with increased femoral stem anteversion restored ROM in five positions and showed only a 2% deficiency in the sixth position. Compared with the intact hip, ROM deficits were seen after SRA in the normal and retroverted acetabular positions and to a lesser extent for THA which can be improved with increased femoral stem anteversion.


CONCLUSIONS
Poor ROM may result after SRA if acetabular retroversion is present.
Incavo
Stephen J
SJ
Department of Orthopaedic Surgery, Adult Reconstructive Surgery, The Methodist Hospital for Orthopaedics, 6550 Fannin, Suite 2500, Houston, TX 77030, USA. SJIncavo@tmhs.org
Gold
Jonathan E
JE
Exaltacion
Jesse James F
JJ
Thompson
Matthew T
MT
Noble
Philip C
PC
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation; D001696:Biomechanical Phenomena; D002102:Cadaver; D003198:Computer Simulation; D005269:Femur / Q000601:surgery; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008875:Middle Aged; D008953:Models, Anatomic; D011474:Prosthesis Design; D016059:Range of Motion, Articular; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome