{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:59:12Z","timestamp":1779919152675,"version":"3.53.1"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T00:00:00Z","timestamp":1652832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Federal Ministry of Education and Research","award":["01EZ091"],"award-info":[{"award-number":["01EZ091"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>\u201cSafe zones\u201d for cup position are currently being investigated in total hip arthroplasty (THA). This study aimed to evaluate the impact of bony impingement on the safe zone and provide recommendations for cup position in THA. CT scans were performed on 123 patients who underwent a cementless THA. Using the implant data and bone morphology from the CT scans, an impingement detection algorithm simulating range of motion (ROM) determined the presence of prosthetic and\/or bony impingement. An impingement-free zone of motion was determined for each patient. These zones were then compared across all patients to establish an optimized impingement-free \u201csafe zone\u201d. Bony impingement reduced the impingement-free zone of motion in 49.6% (61\/123) of patients. A mean reduction of 23.4% in safe zone size was observed in relation to periprosthetic impingement. The superposition of the safe zones showed the highest probability of impingement-free ROM with cup position angles within 40\u201350\u00b0 of inclination and 20\u201330\u00b0 of anteversion in relation to the applied cup and stem design of this study. Virtual ROM simulations identified bony impingement at the anterosuperior acetabular rim for internal rotation at 90\u00b0 of flexion and at the posteroinferior rim for adduction as the main reasons for bony impingement.<\/jats:p>","DOI":"10.3390\/jpm12050812","type":"journal-article","created":{"date-parts":[[2022,5,18]],"date-time":"2022-05-18T11:59:37Z","timestamp":1652875177000},"page":"812","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Which Safe Zone Is Safe in Total Hip Arthroplasty? The Effect of Bony Impingement"],"prefix":"10.3390","volume":"12","author":[{"given":"Markus","family":"Weber","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Regensburg, 93053 Regensburg, Germany"},{"name":"Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93049 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"von Kunow","sequence":"additional","affiliation":[{"name":"Department of Orthopedic and Trauma Surgery, Barmherzige Brueder Regensburg Medical Center, 93049 Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz","family":"Innmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Meyer","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Regensburg, 93077 Bad Abbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Thieme","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Regensburg, 93077 Bad Abbach, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Jerabek","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Renkawitz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Heidelberg University Hospital, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.arth.2017.08.044","article-title":"Predictors of Outcome After Primary Total Joint Replacement","volume":"33","author":"Weber","year":"2018","journal-title":"J. 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