The Functional Mechanics of the Acetabular Component in Total Hip Arthroplasty

Background: Total hip arthroplasty functional safe zones match postural hip changes to dynamic positioning of the acetabular component. We studied integrating the Anteinclination (AI) cup angle into the spinopelvic environment, defining normative values for all parameters and calculating adjustments to AI for each degree of altered standing pelvic position and postural mobility from these values. A sagittal geometric model was employed to determine these values using established spinopelvic parameter angles.Methods: Theoretical normative Pelvic Incidence (PI) specific values were calculated using a triangular construct employing a linear equation describing the functional relationship between the pelvic parameters at a mobility producing an isosceles solution for normative acetabular angles. Individual optimal AI cup values for altered Sacral Slope (SS)/pelvic tilt (sPT) and mobility (dSS) were calculated using specific ratios of angular change between parameters correcting from these normative values.Results: A PI:SS:sPT ratio of angular change of 3:2:1 at dSS = 25 degrees mobility creates an isosceles condition solving for PI specific theoretical normative values for all construct parameters. Individualized tilt correction applies to each posture a +0.25 degrees AI alteration for each +1 degrees sPT increase from this architectural value. Mobility correction applies a +0.5 degrees standing AI and -0.5 degrees sitting AI alteration for each -1 degrees dSS < 25 degrees, the opposite for each +1 degrees dSS > 25 degrees. The Sacroacetabular angle/ Pelvic acetabular angle (SAA/PAA) index describes the underlying spinopelvic environment the cup functions within.Conclusion: This model quantitatively integrates an implanted acetabular component into the host spinopelvic environment. Theoretical normative and individual optimal cup orientations are passively determined by these conditions of standing pelvic position and mobility. (c) 2022 Elsevier Inc. All rights reserved.