Skip to main content
SpringerLink
Log in

Preliminary optimization of cup-implant orientation in total-hip arthroplasty using a parametric predictive analysis of lower-limb dynamics influenced by spine stiffness

  • Research
  • Published:
Multibody System Dynamics Aims and scope Submit manuscript

Abstract

The traditional Lewinnek safe zone used for Total-Hip Arthroplasty (THA) surgery has been found to be inadequate, as dissatisfaction rates have risen after this surgery. It is evident that spinopelvic parameters and spine stiffness, factors that have been overlooked previously, must be taken into account for optimal surgical outcomes. In this paper, a novel predictive dynamic modeling approach was proposed to address this issue. This approach involved the development of a multibody model of a human that contained nonlinear spinal elements, which was validated by comparing it to literature in-vitro experiments and conducting a motion-capture experiment. To simulate human sit-to-stand motion, this model was employed with an optimal control approach based on trajectory optimization. Human joint angles were extracted from conducted simulations of different scenarios: normal, fused, and stiff spines. It was found that spine stiffness had a significant effect on lower-limb motion and the risk of implant impingement. Different scenarios of spine stiffness were examined, such as different levels of spinal fusion or an anatomically stiff spine. The optimal acetabular-cup orientation was calculated based on implant-impingement criteria using predicted motions for different spinal-condition scenarios, and the results compared to the clinically recommended orientation values for the same categories of patients. Our preliminary optimization suggests increasing the anteversion-cup angle from \(23 ^{\circ }\) (normal spine) to \(29 ^{\circ }\) for an anatomically stiff spine. For fused spines, the angle should fall within the range of 27–38∘, depending on the level of fusion. This research is the first of its kind to examine spine flexibility in different scenarios and its impact on lower-limb motion. The findings of this paper could help improve THA surgical planning and reduce the risk of hip impingement or dislocation after THA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14

Similar content being viewed by others

References

  1. Birrell, F., Johnell, O., Silman, A.: Projecting the need for hip replacement over the next three decades: influence of changing demography and threshold for surgery. Ann. Rheum. Dis. 58, 569–572 (1999)

    Article  Google Scholar 

  2. Canadian Institute for Health Information. Hip and knee replacements in Canada, 2016–2017: Canadian joint replacement registry annual report (2018)

  3. Canadian Institute for Health Information. Hip and knee replacements in Canada, 2017–2018: Canadian joint replacement registry annual report (2019)

  4. Biedermann, R., et al.: Reducing the risk of dislocation after total hip arthroplasty: the effect of orientation of the acetabular component. J. Bone Jt. Surg. 87, 762–769 (2005)

    Article  Google Scholar 

  5. Lewinnek, G.E., Lewis, J., Tarr, R., Compere, C., Zimmerman, J.: Dislocations after total hip-replacement arthroplasties. J. Bone Jt. Surg. 60, 217–220 (1978)

    Article  Google Scholar 

  6. Rivière, C., et al.: The influence of spine-hip relations on total hip replacement: a systematic review. Orthop. Traumatol., Surg. Res. 103, 559–568 (2017)

    Article  Google Scholar 

  7. Abdel, M.P., von Roth, P., Jennings, M.T.,, Hanssen, A.D., Pagnano, M.W.: What safe zone? The vast majority of dislocated thas are within the lewinnek safe zone for acetabular component position. Clin. Orthop. Relat. Res. 474, 386–391 (2016)

    Article  Google Scholar 

  8. Esposito, C.I., et al.: Cup position alone does not predict risk of dislocation after hip arthroplasty. J. Arthroplast. 30, 109–113 (2015)

    Article  Google Scholar 

  9. Vigdorchik, J.M., et al.: 2021 Otto aufranc award: a simple hip-spine classification for total hip arthroplasty: validation and a large multicentre series. Bone Joint J. 103, 17–24 (2021)

    Article  Google Scholar 

  10. Malkani, A.L., et al.: Total hip arthroplasty in patients with previous lumbar fusion surgery: are there more dislocations and revisions? J. Arthroplast. 33, 1189–1193 (2018)

    Article  Google Scholar 

  11. Vigdorchik, J., et al.: Evaluation of the spine is critical in the workup of recurrent instability after total hip arthroplasty. Bone Joint J. 101, 817–823 (2019)

    Article  Google Scholar 

  12. Barrey, C., Jund, J., Noseda, O., Roussouly, P.: Sagittal balance of the pelvis-spine complex and lumbar degenerative diseases. A comparative study about 85 cases. Eur. Spine J. 16, 1459–1467 (2007)

    Article  Google Scholar 

  13. MohammadiNasrabadi, A., McNally, W., Moammer, G., McPhee, J.: Automatic extraction of spinopelvic parameters using deep learning to detect landmarks as objects. In: Medical Imaging with Deep Learning (2022)

    Google Scholar 

  14. MohammadiNasrabadi, A., Moammer, G., McPhee, J.: A review on the effects of spine stiffness, spinal fusion and spinopelvic parameters on lower limb motion and total hip arthroplasty outcomes (2023)

  15. Mancino, F., et al.: Surgical implications of the hip-spine relationship in total hip arthroplasty. Orthopedic Reviews 12 (2020)

  16. Lee, S.H., Lim, C.W., Choi, K.Y., Jo, S.: Effect of spine-pelvis relationship in total hip arthroplasty. Hip Pelvis 31, 4–10 (2019)

    Article  Google Scholar 

  17. Sultan, A.A., et al.: The impact of spino-pelvic alignment on total hip arthroplasty outcomes: a critical analysis of current evidence. J. Arthroplast. 33, 1606–1616 (2018)

    Article  Google Scholar 

  18. Buckland, A., et al.: Dislocation of a primary total hip arthroplasty is more common in patients with a lumbar spinal fusion. Bone Joint J. 99, 585–591 (2017)

    Article  Google Scholar 

  19. Vigdorchik, J.M., et al.: The majority of total hip arthroplasty patients with a stiff spine do not have an instrumented fusion. J. Arthroplast. 35, S252–S254 (2020)

    Article  Google Scholar 

  20. Barry, J.J., Sing, D.C., Vail, T.P., Hansen, E.N.: Early outcomes of primary total hip arthroplasty after prior lumbar spinal fusion. J. Arthroplast. 32, 470–474 (2017)

    Article  Google Scholar 

  21. Lazennec, J.Y., Clark, I.C., Folinais, D., Tahar, I.N., Pour, A.E.: What is the impact of a spinal fusion on acetabular implant orientation in functional standing and sitting positions? J. Arthroplast. 32, 3184–3190 (2017)

    Article  Google Scholar 

  22. Heckmann, N., et al.: Late dislocation following total hip arthroplasty: spinopelvic imbalance as a causative factor. J. Bone Jt. Surg. 100, 1845–1853 (2018)

    Article  Google Scholar 

  23. Salib, C., et al.: Lumbar fusion involving the sacrum increases dislocation risk in primary total hip arthroplasty. Bone Joint J. 101, 198–206 (2019)

    Article  Google Scholar 

  24. Cornaz, F., et al.: Intervertebral disc degeneration relates to biomechanical changes of spinal ligaments. Spine J. 21, 1399–1407 (2021)

    Article  Google Scholar 

  25. Alkalay, R.: The material and mechanical properties of the healthy and degenerated intervertebral disc. Integrated biomaterials science, 403–424 (2002)

  26. Tomasi, M., Artoni, A., Mattei, L., Di Puccio, F.: On the estimation of hip joint loads through musculoskeletal modeling. Biomechanics and Modeling in Mechanobiology, 1–22 (2022)

  27. Eftekhary, N., et al.: A systematic approach to the hip-spine relationship and its applications to total hip arthroplasty. Bone Joint J. 101, 808–816 (2019)

    Article  Google Scholar 

  28. Ezquerra, L., Quilez, M.P., Pérez, M.Á., Albareda, J., Seral, B.: Range of movement for impingement and dislocation avoidance in total hip replacement predicted by finite element model. J. Med. Biol. Eng. 37, 26–34 (2017)

    Article  Google Scholar 

  29. Widmer, K.-H.: The impingement-free, prosthesis-specific, and anatomy-adjusted combined target zone for component positioning in tha depends on design and implantation parameters of both components. Clin. Orthop. Relat. Res. 478, 1904 (2020)

    Article  Google Scholar 

  30. Kebbach, M., et al.: Do hip resurfacing and short hip stem arthroplasties differ from conventional hip stem arthroplasties regarding impingement-free range of motion? Journal of Orthopaedic Research® (2023)

  31. Pour, A.E., et al.: Is combined anteversion equally affected by acetabular cup and femoral stem anteversion? J. Arthroplast. 36, 2393–2401 (2021)

    Article  Google Scholar 

  32. Tang, H., et al.: A modeling study of a patient-specific safe zone for tha: calculation, validation, and key factors based on standing and sitting sagittal pelvic tilt. Clin. Orthop. Relat. Res. 480, 191–205 (2022)

    Article  Google Scholar 

  33. Aqil, A., Shah, N.: Diagnosis of the failed total hip replacement. Journal of Clinical Orthopaedics and Trauma 11, 2–8 (2020)

  34. Boonstra, M.C., Schreurs, B.W., Verdonschot, N.: The sit-to-stand movement: differences in performance between patients after primary total hip arthroplasty and revision total hip arthroplasty with acetabular bone impaction grafting. Phys. Ther. 91, 547–554 (2011)

    Article  Google Scholar 

  35. Morrison, T.M., Pathmanathan, P., Adwan, M., Margerrison, E.: Advancing regulatory science with computational modeling for medical devices at the fda’s office of science and engineering laboratories. Front. Med. 5, 241 (2018)

    Article  Google Scholar 

  36. Saker, E., Tubbs, R.S.: Anatomy of the lumbar intervertebral discs. In: Anatomy of the Lumbar Intervertebral Discs Chap. 1, Sect. 1, pp. 10–13 (1992)

    Google Scholar 

  37. Pintar, F.A., Yoganandan, N., Myers, T., Elhagediab, A., Sances, A. Jr: Biomechanical properties of human lumbar spine ligaments. J. Biomech. 25, 1351–1356 (1992)

    Article  Google Scholar 

  38. Shirazi-Adl, A., Ahmed, A.M., Shrivastava, S.C.: Mechanical response of a lumbar motion segment in axial torque alone and combined with compression. Spine 11, 914–927 (1986)

    Article  Google Scholar 

  39. Damm, N., Rockenfeller, R., Gruber, K.: Lumbar spinal ligament characteristics extracted from stepwise reduction experiments allow for preciser modeling than literature data. Biomech. Model. Mechanobiol. 19, 893–910 (2020)

    Article  Google Scholar 

  40. Mörl, F., Günther, M., Riede, J.M., Hammer, M., Schmitt, S.: Loads distributed in vivo among vertebrae, muscles, spinal ligaments, and intervertebral discs in a passively flexed lumbar spine. Biomech. Model. Mechanobiol. 19, 2015–2047 (2020)

    Article  Google Scholar 

  41. Jalalian, A., Tay, F.E., Arastehfar, S., Liu, G.: A patient-specific multibody kinematic model for representation of the scoliotic spine movement in frontal plane of the human body. Multibody Syst. Dyn. 39, 197–220 (2017)

    Article  Google Scholar 

  42. Rupp, T., Ehlers, W., Karajan, N., Günther, M., Schmitt, S.: A forward dynamics simulation of human lumbar spine flexion predicting the load sharing of intervertebral discs, ligaments, and muscles. Biomech. Model. Mechanobiol. 14, 1081–1105 (2015)

    Article  Google Scholar 

  43. Heuer, F., Schmidt, H., Klezl, Z., Claes, L., Wilke, H.-J.: Stepwise reduction of functional spinal structures increase range of motion and change lordosis angle. J. Biomech. 40, 271–280 (2007)

    Article  Google Scholar 

  44. Valentini, P.P., Pennestrì, E.: An improved three-dimensional multibody model of the human spine for vibrational investigations. Multibody Syst. Dyn. 36, 363–375 (2016)

    Article  Google Scholar 

  45. Christophy, M., Curtin, M., Faruk Senan, N.A., Lotz, J.C., O’Reilly, O.M.: On the modeling of the intervertebral joint in multibody models for the spine. Multibody Syst. Dyn. 30, 413–432 (2013)

    Article  MathSciNet  Google Scholar 

  46. Wu, G., et al.: Isb recommendation on definitions of joint coordinate system of various joints for the reporting of human joint motion—part I: ankle, hip, and spine. J. Biomech. 35, 543–548 (2002)

    Article  Google Scholar 

  47. Pearsall, D.J., Reid, J.G., Livingston, L.A.: Segmental inertial parameters of the human trunk as determined from computed tomography. Ann. Biomed. Eng. 24, 198–210 (1996)

    Article  Google Scholar 

  48. Shan, G., Bohn, C.: Anthropometrical data and coefficients of regression related to gender and race. Appl. Ergon. 34, 327–337 (2003)

    Article  Google Scholar 

  49. Vette, A.H., Yoshida, T., Thrasher, T.A., Masani, K., Popovic, M.R.: A complete, non-lumped, and verifiable set of upper body segment parameters for three-dimensional dynamic modeling. Med. Eng. Phys. 33, 70–79 (2011)

    Article  Google Scholar 

  50. Kelly, M.: An introduction to trajectory optimization: how to do your own direct collocation. SIAM Rev. 59, 849–904 (2017)

    Article  MathSciNet  MATH  Google Scholar 

  51. Norman-Gerum, V., McPhee, J.: Constrained dynamic optimization of sit-to-stand motion driven by Bézier curves. J. Biomech. Eng. 140, 121011 (2018)

    Article  Google Scholar 

  52. Tkaczuk, H.: Tensile properties of human lumbar longitudinal ligaments. Acta Orthop. Scand. 39, 1–69 (1968)

    Article  Google Scholar 

  53. Hsu, J., de la Fuente, M., Radermacher, K.: Calculation of impingement-free combined cup and stem alignments based on the patient-specific pelvic tilt. J. Biomech. 82, 193–203 (2019)

    Article  Google Scholar 

  54. Danaei, B., McPhee, J.: Model-based acetabular cup orientation optimization based on minimizing the risk of edge-loading and implant impingement following total hip arthroplasty. J. Biomech. Eng. 144, 111008 (2022)

    Article  Google Scholar 

  55. Murray, D.: The definition and measurement of acetabular orientation. J. Bone Jt. Surg., Br. Vol. 75, 228–232 (1993)

    Article  Google Scholar 

  56. D’Lima, D.D., et al.: Standard for hip joint coordinate system recommendations from the isb standardization committee. Jul 17, 1–8 (2000)

  57. Dorr, L.D., Malik, A., Wan, Z., Long, W.T., Harris, M.: Precision and bias of imageless computer navigation and surgeon estimates for acetabular component position. Clin. Orthop. Relat. Res. 465, 92–99 (2007)

    Article  Google Scholar 

  58. Esposito, C.I., et al.: Total hip arthroplasty patients with fixed spinopelvic alignment are at higher risk of hip dislocation. J. Arthroplast. 33, 1449–1454 (2018)

    Article  Google Scholar 

  59. Wan, Z., Malik, A., Jaramaz, B., Chao, L., Dorr, L.D.: Imaging and navigation measurement of acetabular component position in tha. Clin. Orthop. Relat. Res. 467, 32–42 (2009)

    Article  Google Scholar 

  60. Wilke, H.-J., Schmidt, H., Werner, K., Schmölz, W., Drumm, J.: Biomechanical evaluation of a new total posterior-element replacement system. Spine 31, 2790–2796 (2006)

    Article  Google Scholar 

  61. Lum, Z.C., Coury, J.G., Cohen, J.L., Dorr, L.D.: The current knowledge on spinopelvic mobility. J. Arthroplast. 33, 291–296 (2018)

    Article  Google Scholar 

  62. Widmer, K.-H., Zurfluh, B.: Compliant positioning of total hip components for optimal range of motion. J. Orthop. Res. 22, 815–821 (2004)

    Article  Google Scholar 

  63. Elkins, J.M., Callaghan, J.J., Brown, T.D.: The 2014 frank stinchfield award: the ‘landing zone’ for wear and stability in total hip arthroplasty is smaller than we thought: a computational analysis. Clin. Orthop. Relat. Res. 473, 441–452 (2015)

    Article  Google Scholar 

  64. Monteiro, N.M.B., da Silva, M.P.T., Folgado, J.O.M.G., Melancia, J.P.L.: Structural analysis of the intervertebral discs adjacent to an interbody fusion using multibody dynamics and finite element cosimulation. Multibody Syst. Dyn. 25, 245–270 (2011)

    Article  Google Scholar 

Download references

Acknowledgements

This research was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and Intellijoint Surgical.

Funding

This research was funded by the Natural Sciences and Engineering Research Council of Canada (NSERC) and Intellijoint Surgical.

Author information

Authors and Affiliations

  1. Department of Systems Design Engineering, University of Waterloo, 200 University Ave W, Waterloo, N2L 3G1, ON, Canada

    AliAsghar MohammadiNasrabadi & John McPhee

Authors
  1. AliAsghar MohammadiNasrabadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John McPhee
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AliAsghar MohammadiNasrabadi contributed to the conceptualization and design of the study, data collection, analysis, and manuscript writing, review and editing. John McPhee contributed to conceptualization and design of the study, funding acquisition, supervision, providing critical feedback, writing and revising the manuscript. Both authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to AliAsghar MohammadiNasrabadi.

Ethics declarations

Ethics approval

This study involving human subjects received approval from the University of Waterloo Ethical Review Board. The research was conducted in accordance with the “multibody biomechanical modeling of activities of daily living” that has been reviewed and approved by the University of Waterloo Ethical Board. Consent to participate was obtained from all participants, and consent to publish their data was also obtained.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

MohammadiNasrabadi, A., McPhee, J. Preliminary optimization of cup-implant orientation in total-hip arthroplasty using a parametric predictive analysis of lower-limb dynamics influenced by spine stiffness. Multibody Syst Dyn (2023). https://doi.org/10.1007/s11044-023-09951-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11044-023-09951-3

Keywords

Search

Navigation