Dynamic acetabular cup orientation during gait: a study of fast and slow walking total hip replacement patients

Abstract

The dynamic orientation of total hip replacement acetabular cups during walking may vary sub-stantially from their assumed position at surgical implantation and may vary between individuals. The scale of this effect is of interest for both pre-clinical device testing and for pre-operative sur-gical planning. This work aimed to evaluate: 1) patient variation in dynamic cup orientation; 2) whether walking speed was a candidate proxy measure for the dynamic cup orientation; and 3) the relationships between dynamic cup orientation angles and planar pelvic angles. Pelvic movement data for patients with fast (n=20) and slow (n=19) self-selected walking speeds, was used to calcu-late acetabular cup inclination and version angles through gait. For aim 1, the range and extremes of acetabular cup orientation angles were analysed for all patients. Large patient to patient varia-tion was found in the range of both inclination angle (1° to 11°) and version angle (4° to 18°). The version angle was typically retroverted in comparison to the implantation position (greatest devi-ation 27o). This orientation is substantially different to the static, 0° version simplifying assump-tions in pre-clinical ‘edge loading’ testing. For aim 2, the cup orientation angles were compared between the fast and slow walking groups using statistical parametric mapping. The only signifi-cant differences observed were for cup version angle, for ~12% of the gait cycle, before toe-off (p < 0.05). Therefore, self-selected walking speed, in isolation, is not a sufficient proxy measure for dynamic acetabular orientation. For aim 3, correlations were recorded between the acetabular cup orientation angles and the planar pelvic angles. The cup inclination angle during gait was strongly correlated (Spearman’s coefficient -1) with pelvic obliquity alone, indicating that simple planar assessment could be used to anticipate range of inclination angle. The cup version angle was cor-related with both pelvic rotation and tilt (Spearman’s coefficient 0.8-1), indicating that cup version cannot be predicted directly from any single pelvic movement. This complexity, along with the interaction between inclination angle and range of version angle, supports the use of computa-tional tools to aid clinical understanding.