Bruce H. Robie

Influence of total hip design on dislocation: a computer model and clinical analysis.

Dislocation following hip arthroplasty remains problematic. While the etiology of dislocation may be multifactorial, implant system design may play a role. Using a computer aided design program, virtual range of motion of several commonly implanted designs was performed with prosthetic interference representing impingement used as an endpoint. Implants with small diameter head size (22mm) and a larger trunion geometry (type II taper) demonstrated impingement in flexion at less than 90°, suggesting an increased risk for dislocation. To investigate this clinically, we performed a review of a consecutive series of 254 primary hip arthroplasties performed by a single surgeon using an implant with a type II taper (Biomet™, Warsaw, IN). At a minimum 2 year followup, 12 patients with 12 hips (4.8%) had at least one episode of dislocation. Stratified by head size, the dislocation rates were 3.6% for 28 mm, 4.8% for 26 mm, and 18.8% for 22mm bearings. These findings support the notion that computer aided design modeling of implant systems is useful in evaluating range of motion and this technique could be employed during the design of any new implant system.Level of Evidence: Therapeutic study, level IV (case series). See Guidelines for Authors for a complete description of levels of evidence.

Prosthetic Design and Patellofemoral Function

In the early 1970’s, devices like the duocondylar knee were used to treat tibiofemoral arthritis, leaving the patellofemoral joint intact (22). Later that decade, the duopatellar and the total condylar knees (25, 14) replaced the patellofemoral joint as well as the tibiofemoral joint. Initially, these knee replacements were used both with and without patellar resurfacing. However, long-term follow-up of patients who did not receive a patellar replacement found a high incidence of reoperation to replace the patella articulation and relieve pain (15). This finding led to standard tricompartmental total knee arthroplasty.