Defining the Optimal Position of the Lipped Liner in Combination with Cup Orientation and Stem Version

Overview

Journal Bone Joint Res

Date 2023 Sep 20

PMID 37727965

Authors

Alessandro Navacchia

Joseph Pagkalos

Edward T Davis

Affiliations

Soon will be listed here.

Abstract

Aims: The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice.

Methods: A model of a THA was developed using a 20° lipped liner. Kinematic analyses included a physiological range of motion (ROM) analysis and a provocative dislocation manoeuvre analysis. ROM prior to impingement was calculated and, in impingement scenarios, the travel distance prior to dislocation was assessed. The combinations analyzed included nine cup positions (inclination 30-40-50°, anteversion 5-15-25°), three stem positions (anteversion 0-15-30°), and five lip orientations (right hip 7 to 11 o'clock).

Results: The position of the lip changes the ROM prior to impingement, with certain combinations leading to impingement within the physiological ROM. Inferior lip positions (7 to 8 o'clock) performed best with cup inclinations of 30° and 40°. Superior lip positions performed best with cup inclination of 50°. When impingement occurs in the plane of the lip, the lip increases the travel distance prior to dislocation. Inferior lip positions led to the largest increase in jump distance in a posterior dislocation provocation manoeuvre.

Conclusion: The lip orientation that provides optimal physiological ROM depends on the orientation of the cup and stem. For a THA with stem anteversion 15°, cup inclination 40°, and cup anteversion 15°, the optimal lip position was posterior-inferior (8 o'clock). Maximizing jump distance prior to dislocation while preventing impingement in the opposite direction is possible with appropriate lip positioning.

Citing Articles

Impact of CT-based navigation, large femoral head, and dual-mobility liner on achieving the required range of motion in total hip arthroplasty.

Konishi T, Hamai S, Kawahara S, Hara D, Sato T, Motomura G Bone Jt Open. 2025; 6(2):155-163.

PMID: 39919725 PMC: 11805587. DOI: 10.1302/2633-1462.62.BJO-2024-0084.R1.

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