Simulation of hip bony range of motion (BROM) corresponds to the observed functional range of motion (FROM) for pure flexion, internal rotation in deep flexion, and external rotation in minimal flexion-extension - A cadaver study.

Abstract

Background: The study investigated the relationship between computed bony range of motion (BROM) and actual functional range of motion (FROM) as directly measured in cadaveric hips. The hypothesis was that some hip movements are not substantially restricted by soft tissues, and therefore, computed BROM for these movements may effectively represent FROM, providing a reliable parameter for computational pre-operative planning.

Methods: Maximum passive FROM was measured in nine cadaveric hips using optical tracking. Each hip was measured in at least ninety FROM positions, covering flexion, extension, abduction, flexion-internal rotation (IR), flexion-external rotation (ER), extension-IR, and extension-ER movements. The measured FROM was virtually recreated using 3D models of the femur and pelvis derived from CT scans, and the corresponding BROM was computed. The relationship between FROM and BROM was classified into three groups: close (mean difference<5°), moderate (mean difference 5-15°), and weak (mean difference>15°).

Results: The relationship between FROM and BROM was close for pure flexion (difference = 3.1° ± 3.9°) and IR in deep (>70°) flexion (difference = 4.3° ± 4.6°). The relationship was moderate for ER in minimal flexion (difference = 10.3° ± 5.8°) and ER in minimal extension (difference = 11.7° ± 7.2°). Bony impingement was observed in some cases during these movements. Other movements showed a weak relationship: large differences were observed in extension (51.9° ± 14.4°), abduction (18.6° ± 11.3°), flexion-IR at flexion<70° (37.1° ± 9.4°), extension-IR (79.6° ± 4.8°), flexion-ER at flexion>30° (45.9° ± 11.3°), and extension-ER at extension>20° (15.8° ± 4.8°).

Conclusion: BROM simulations of hip flexion, IR in deep flexion, and ER in low flexion/extension may be useful in dynamic pre-operative planning of total hip arthroplasty.