Development of bony range of motion (B-ROM) boundary for total hip replacement planning. (July 2022)

• Record Type: Journal Article
• Authors: Palit, Arnab; King, Richard; Pierrepont, Jim; Williams, Mark A
• Is Part Of: Computer methods and programs in biomedicine. Volume 222(2022)
• Publication Date: 2022-07
• Subjects: Range of motion (ROM) -- Hip joint -- Prosthetic impingement -- Bony impingement -- Edge loading -- Activities of daily living -- Total hip replacement; ROM Range of Motion -- B-ROM BonyRange of Motion -- F-ROM FunctionalRange of Motion -- FE Flexion - Extension -- AA Abduction - Adduction -- IRER Internal Rotation - External Rotation -- Flex Flexion -- Extn Extension -- Abd Abduction -- Add Adduction -- IR Internal Rotation -- ER External Rotation -- ADLs Activities of Daily Livings -- HJC Hip Joint Centre -- PCS Pelvic Coordinate System -- FCS Femur Coordinate System -- WCS World Coordinate System -- ASISRight Right Anterior Superior Iliac Spines -- ASISLeft Left Anterior Superior Iliac Spines -- PTUBRight Right Pubic Tubercles -- PTUBLef Left Pubic Tubercles -- EPILateral Lateral Epicondyle -- EPIMadial Medial Epicondyle -- APP Anterior Pelvic Plane -- KC Knee Centre; Medicine -- Computer programs -- Periodicals; Biology -- Computer programs -- Periodicals; Computers -- Periodicals; Medicine -- Periodicals; Médecine -- Logiciels -- Périodiques; Biologie -- Logiciels -- Périodiques; Biology -- Computer programs; Medicine -- Computer programs; Periodicals; Electronic journals; 610.28
• DOI: 10.1016/j.cmpb.2022.106937
• Languages: English
• ISSNs: 0169-2607

Abstract

Highlights: Developed a representative bony range of motion (B-ROM) to cover all the possible hip joint motions in 3D. The B-ROM is presented in terms of pure joint motions i.e., amount of flexion-extension, abduction-adduction, internal-external rotations and their combinations. The B-ROM of a contralateral healthy hip of a patient can be used as a subject-specific target values to determine best possible B-ROM of the planned side. B-ROM method could be integrated with any exiting hip replacement planning tool. Abstract: Background and objective: Pre-operative surgical planning using computer simulation is increasingly standard practice before Total Hip Arthroplasty (THA), in order to determine the optimal implant positions, and thereby minimise post-operative complications such as dislocation, wear and leg length discrepancy. One of the limitations of current methods, however, is the lack of information on the subject-specific reference range of motion (ROM) that could be used as targets for surgical planning. Only a limited number of hip motions are considered, which are neither subject-specific, nor representative of all the hip motions associated with all the activities of daily livings (ADLs). In this paper, therefore, a method was developed to calculate subject-specific representative bony range of motion (B-ROM) that would cover all the possible joint motions and presented in terms of pure joint motions. Methods: Only 3D bone geometries of femur and pelvis, constructed from personalised CT scan, were used as inputs for healthy hip joint whereas implant geometries and their positions on native bone geometries were required for planned treatment side or replaced side. Hip joint motion simulation was carried out using six different Tait-Bryan intrinsic rotation sequences of three pure joint motions - flexion-extension, abduction-adduction and internal-external rotation, and B-ROM was then identified for any of these six different sequences which caused earliest feasible impingement. The B-ROM could be used as a list of ROM data points or visualised as multiple 2D surface plots or a 3D envelop. Using the developed method, the B-ROM of a contralateral healthy hip joint of a patient can be used to define the subject-specific target ROM values to inform the surgical planning of the arthritic hip side so that the patient's natural ROM could be restored as closely as possible by the planned implant placements. This was demonstrated with a clinical verification study using 'non-dislocating' and 'dislocating' THA patients. Results: The results supported the study hypothesis that the percentage of intersected volume of the healthy and replaced side B-ROM was higher for the 'Non-Dislocator' patient (95%) compared to 'Dislocator' (78%). Also, the results showed that the only one sequence (first flexion-extension, then abduction-adduction and finally internal-external rotation) was not adequate to identify all the possible limiting B-ROM, and therefore, all the six rotation sequences should be considered. Conclusions: The method encompasses every potential ADL, and as a result, more comprehensive surgical planning is possible, as the implant positions can be optimised in order to maximise impingement-free ROM, and consequently minimise clinical complications.