Modular Necks Improve the Range of Hip Motion in Cases with Excessively Anteverted or Retroverted Femurs in THA

Background Anteversion of an acetabular component often is difficult to ascertain in patients with THA in whom excessively anteverted or retroverted femurs may result in limited ROM or risk of dislocation. Restriction of motion, however, is determined by the combination of version of both components.

Questions/purposes We therefore determined the combined anteversion values that provide adequate ROM. We varied acetabular version by differing implantations and varied femoral version with modular necks.

Methods ROM was tested by changing cup anteversion after setting the femoral version to 20° or 60° anteversion or 20° retroversion. The angle of the modular neck was adjusted in 11 increments of 5° each. Range of internal rotation (IR) at 90° flexion, external rotation (ER) at 0° extension, and flexion (Flex) were measured when any impingement occurred before dislocation. We defined a required ROM as having 40° IR, 30° ER, and 110° Flex.

Results At 60° anteversion, ER was less than 10° even when the acetabular component was set at 10° retroversion because of posterior impingement. When a modular neck with 25° retroversion was used, ER improved to greater than 30°. At 20° retroversion, IR was 31° even when the acetabular component was opened to 35° anteversion. IR improved to 34° and 40° with 20° and 25° anteverted modular necks, respectively.

Conclusions and Clinical Relevance In cases with excessive femoral anteversion or retroversion, the required ROM could not be achieved by simply changing the version of acetabular components. The adjustment of femoral versions using the modular necks allowed additional improvement of ROM.