The effect of seated pelvic tilt on posterior edge-loading in total hip arthroplasty: A finite element investigation

Abstract

Edge-loading of a ceramic-on-ceramic total hip replacement can lead to reproducible squeaking and revision. A patient’s functional acetabular cup orientation, driven by their pelvic tilt, has been shown to be a significant factor in squeaking during hip flexion. The aim of this study was to investigate the effect of seated pelvic tilt on the contact mechanics at the ceramic bearing surface. A finite element model of a ceramic-on-ceramic total hip replacement was created. The cup was orientated at 40° inclination and 15° anteversion relative to the anterior pelvic plane. The stem was flexed 90° to replicate sitting in a chair. The model was loaded using data from in vivo measurements taken during a sit-to-stand activity. The pelvis was modelled in seven different sagittal positions, ranging from −30° to 30° of pelvic tilt, where a positive value denotes anterior pelvic tilt. Three different head sizes were investigated: 32, 36 and 40 mm. The maximum contact pressure and contact patch to rim distance were determined for each of the 21 simulations. Edge-loading (contact patch to rim distance < 0 mm) occurred with all head sizes when seated pelvic tilt was ≥10° and induced a large increase in contact pressure on the liner, with a maximum pressure exceeding 500 MPa. Edge-loading initiated at seated pelvic tilts of 7°, 9° and 5° for the 32, 36 and 40 mm heads, respectively. Patients with anterior pelvic tilts in the seated position are susceptible to posterior edge-loading. As the position of the pelvis when seated is patient specific, cup orientation should be adjusted on an individual basis to minimise edge-loading.

Keywords

Hip biomechanics finite element modelling/analysis (medical)contact mechanics orthopaedic tribology implants/prosthetics

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References

Hua

Jin

et al . The contact mechanics and occurrence of edge loading in modular metal-on-polyethylene total hip replacement during daily activities. Med Eng Phys 2016; 38(6): 518–525.

Yoon

Le Duff

Johnson

et al . Contact patch to rim distance predicts metal ion levels in hip resurfacing. Clin Orthop Relat Res 2013; 471(5): 1615–1621.

Underwood

Matthies

Cann

et al . A comparison of explanted articular surface replacement and Birmingham hip resurfacing components. J Bone Joint Surg Br 2011; 93(9): 1169–1177.

Matthies

Underwood

Cann

et al . Retrieval analysis of 240 metal-on-metal hip components, comparing modular total hip replacement with hip resurfacing. J Bone Joint Surg Br 2011; 93(3): 307–314.

Esposito

Walter

Roques

et al . Wear in alumina-on-alumina ceramic total hip replacements: a retrieval analysis of edge loading. J Bone Joint Surg Br 2012; 94(7): 901–907.

Morlock

Bishop

Zustin

et al . Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens. J Bone Joint Surg Am 2008; 90(Suppl. 3): 89–95.

Sanders

Tibbitts

Brannon

Concomitant evolution of wear and squeaking in dual-severity, lubricated wear testing of ceramic-on-ceramic hip prostheses. J Orthop Res 2012; 30(9): 1377–1383.

Sanders

Dudhiya

Brannon

RM.

Thin hard crest on the edge of ceramic acetabular liners accelerates wear in edge loading. J Arthroplasty 2012; 27(1): 150–152.

McDonnell

Boyce

Bare

et al . The incidence of noise generation arising from the large-diameter delta motion ceramic total hip bearing. Bone Joint J 2013; 95-B(2): 160–165.

10.

Sexton

Yeung

Jackson

et al . The role of patient factors and implant position in squeaking of ceramic-on-ceramic total hip replacements. J Bone Joint Surg Br 2011; 93(4): 439–442.

11.

Patil

Bergula

Chen

et al . Polyethylene wear and acetabular component orientation. J Bone Joint Surg Am 2003; 85-A(Suppl. 4): 56–63.

12.

Wan

Boutary

Dorr

LD.

The influence of acetabular component position on wear in total hip arthroplasty. J Arthroplasty 2008; 23(1): 51–56.

13.

Hart

Buddhdev

Winship

et al . Cup inclination angle of greater than 50 degrees increases whole blood concentrations of cobalt and chromium ions after metal-on-metal hip resurfacing. Hip Int 2008; 18(3): 212–219.

14.

De Haan

Pattyn

Gill

et al . Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement. J Bone Joint Surg Br 2008; 90(10): 1291–1297.

15.

Hart

Ilo

Underwood

et al . The relationship between the angle of version and rate of wear of retrieved metal-on-metal resurfacings: a prospective, CT-based study. J Bone Joint Surg Br 2011; 93(3): 315–320.

16.

Elkins

Pedersen

Callaghan

et al . Do obesity and/or stripe wear increase ceramic liner fracture risk? An XFEM analysis. Clin Orthop Relat Res 2013; 471(2): 527–536.

17.

Pierrepont

Feyen

Miles

et al . Functional orientation of the acetabular component in ceramic-on-ceramic total hip arthroplasty and its relevance to squeaking. Bone Joint J 2016; 98-B(7): 910–916.

18.

Pierrepont

Hawdon

Miles

et al . Variation in functional pelvic tilt in patients undergoing total hip arthroplasty. Bone Joint J 2017; 99-B(2): 184–191.

19.

Matthies

Henckel

Cro

et al . Predicting wear and blood metal ion levels in metal-on-metal hip resurfacing. J Orthop Res 2014; 32(1): 167–174.

20.

Le Duff

Ebramzadeh

Amstutz

HC.

Contact patch to rim distance: the quintessential tool for metal-on-metal bearing in vivo performance analysis: a review. Hip Int 2017; 27(3): 220–225.

21.

Mak

Jin

ZM.

Analysis of contact mechanics in ceramic-on-ceramic hip joint replacements. Proc IMechE, Part H: J Engineering in Medicine 2002; 216 (4): 231–236.

22.

Elkins

O’Brien

Stroud

et al . Hard-on-hard total hip impingement causes extreme contact stress concentrations. Clin Orthop Relat Res 2011; 469(2): 454–463.

23.

Elkins

Pedersen

Callaghan

et al . Fracture propagation propensity of ceramic liners during impingement-subluxation: a finite element exploration. J Arthroplasty 2012; 27: 520–526.

24.

Al-Hajjar

Leslie

Tipper

et al . Effect of cup inclination angle during microseparation and rim loading on the wear of BIOLOX^® delta ceramic-on-ceramic total hip replacement. J Biomed Mater Res B Appl Biomater 2010; 95(2): 263–268.

25.

Sariali

Stewart

Jin

et al . Effect of cup abduction angle and head lateral microseparation on contact stresses in ceramic-on-ceramic total hip arthroplasty. J Biomech 2012; 45(2): 390–393.

26.

Mak

Jin

Fisher

et al . Influence of acetabular cup rim design on the contact stress during edge loading in ceramic-on-ceramic hip prostheses. J Arthroplasty 2011; 26(1): 131–136.

27.

Meng

Wang

Yang

et al . The lubrication performance of the ceramic-on-ceramic hip implant under starved conditions. J Mech Behav Biomed Mater 2015; 50: 70–76.

28.

Al-Hajjar

Fisher

Tipper

et al . Wear of 36-mm BIOLOX^® delta ceramic-on-ceramic bearing in total hip replacements under edge loading conditions. Proc IMechE, Part H: J Engineering in Medicine 2013; 227(5): 535–542.

29.

Renkawitz

Haimerl

Dohmen

et al . The association between femoral tilt and impingement-free range-of-motion in total hip arthroplasty. BMC Musculoskelet Disord 2012; 13: 65.

30.

Hartel

Petersik

Schmidt

et al . Determination of femoral neck angle and torsion angle utilizing a novel three-dimensional modeling and analytical technology based on CT datasets. PLoS ONE 2016; 11(3): e0149480.

31.

Lewinnek

Lewis

Tarr

et al . Dislocations after total hip-replacement arthroplasties. J Bone Joint Surg Am 1978; 60(2): 217–220.

32.

Vrbka

Necas

Bartosik

et al . Determination of a friction coefficient for THA bearing couples. Acta Chir Orthop Traumatol Cech 2015; 82(5): 341–347.

33.

Bergmann

Graichen

Rohlmann

et al . Realistic loads for testing hip implants. Biomed Mater Eng 2010; 20(2): 65–75.

34.

Hua

Wang

et al . Contact mechanics of modular metal-on-polyethylene total hip replacement under adverse edge loading conditions. J Biomech 2014; 47(13): 3303–3309.

35.

Kanawade

Dorr

Wan

Predictability of acetabular component angular change with postural shift from standing to sitting position. J Bone Joint Surg Am 2014; 96(12): 978–986.

36.

Nevelos

Ingham

Doyle

et al . Microseparation of the centers of alumina-alumina artificial hip joints during simulator testing produces clinically relevant wear rates and patterns. J Arthroplasty 2000; 15(6): 793–795.