Does Individualization of Cup Position Affect Prosthetic or Bone Impingement Following Total Hip Arthroplasty?

Spinopelvic (SP) mobility patterns during postural changes affect three-dimensional acetabular component position, the incidence of prosthetic impingement, and total hip arthroplasty (THA) instability. Surgeons have commonly placed the acetabular component in a similar "safe zone" for most patients. Our purpose was to determine the incidence of bone and prosthetic impingement with various cup orientations and determine if a preoperative SP analysis with individualized cup orientation lessens impingement.

A preoperative SP evaluation of 78 THA subjects was performed. Data were analyzed using a software program to determine the prevalence of prosthetic and bone impingement with a patient individualized cup orientation versus 6 commonly selected cup orientations. Impingement was correlated with known SP risk factors for dislocation.

Prosthetic impingement was least with the individualized choice of cup position (9%) versus preselected cup positions (18%-61%). The presence of bone impingement (33%) was similar in all groups and not affected by cup position. Factors associated with impingement in flexion were age, lumbar flexion, pelvic tilt (stand to flexed seated), and functional femoral stem anteversion. Risk factors in extension included standing pelvic tilt, standing SP tilt, lumbar flexion, pelvic rotation (supine to stand and stand to flexed seated), and functional femoral stem anteversion.

Prosthetic impingement is reduced with individualized cup positioning based on SP mobility patterns. Bone impingement occurred in one-third of patients and is a noteworthy consideration in preoperative THA planning. Known SP risk factors for THA instability correlated with the presence of prosthetic impingement in both flexion and extension.