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Hidaka R, Matsuda K, Nakamura S, Nakamura M, Kawano H. Clinical effects of combined anteversion and offset on postoperative dislocation in total hip arthroplasty. ARTHROPLASTY 2024; 6:22. [PMID: 38704579 PMCID: PMC11070079 DOI: 10.1186/s42836-024-00245-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Implant impingement and soft tissue tension are factors involved in dislocation after total hip arthroplasty (THA). Combined anteversion (CA) has been used as an indicator for implant placement. However, optimal implant placement remains a challenge. Moreover, the effect of changes in offset on dislocation is still unclear. In this study, we aimed to clarify the effects of postoperative CA and pre- and postoperative changes in offset on dislocation. METHODS Included were patients who underwent primary cementless THA between 2013 and 2020. The mean values of CA and offset in the dislocation and non-dislocation groups were compared. The CA values within ± 10% of the recommended values were defined as good CA, and those outside the range were rated as poor CA. The dislocation rates were compared between the good and poor CA groups and between the groups with and without increased offset. RESULTS A total of 283 hips were included. The mean values of CA in the dislocation and non-dislocation groups were significantly different (P < 0.05). The dislocation rate was significantly lower in the good CA group (P < 0.05). The dislocation rates in the groups with and without increased total offset were 0.5% and 4.3%, respectively (P = 0.004). There were no dislocations in patients with good CA and increased offset. CONCLUSIONS The dislocation rate was significantly lower when implants were placed within ± 10% of the recommended CA value. Our results suggest that dislocation can be avoided by placing the implant in the good CA range and considering the increase in total offset on the operative side.
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Affiliation(s)
- Ryo Hidaka
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
| | - Kenta Matsuda
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan.
| | - Shigeru Nakamura
- Department of Orthopedic Surgery, Nishitokyo Chuo General Hospital, 2-4-19, Shibakubo-Cho, Nishitokyo, Tokyo, 188-0014, Japan
| | - Masaki Nakamura
- Department of Orthopedic Surgery, Toranomon Hospital, 2-2-2, Toranomon, Minato-Ku, Tokyo, 105-8470, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Weldon E, Agonias K, DeJesus J, Weldon RH, Au DLMT, Nakasone CK. Extended offset stems are infrequently required in anterior approach total hip arthroplasty and low usage does not compromise stability. Arch Orthop Trauma Surg 2024; 144:2365-2372. [PMID: 38512461 DOI: 10.1007/s00402-024-05239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Extended offset (EO) stems are commonly used in posterior approach (PA) total hip arthroplasty (THA), but usage rates and complications are not well studied with anterior approach (AA) THA. This study evaluated usage rates, radiographic outcomes and complications following AA THA between patients receiving EO stems and a matched cohort receiving standard offset (SO) stems. MATERIALS AND METHODS This retrospective review evaluated 1515 consecutive AA THA performed between 2014 and 2021. The recent 100 EO were included in radiographic and complication analysis and were matched to 100 SO stems based on stem size, procedure (unilateral/bilateral), sex, body mass index (BMI), and age. Data collection included patient demographics; pre- and postoperative radiographic measurements of leg length difference (LLD) and global hip offset difference (GHOD); and complications within 1 year. Independent t-tests and Chi-squared analyses compared EO and SO groups. RESULTS EO was utilized in 8% of all AA THA. Despite matching procedures, the distribution of racial groups was different between EO and SO groups, respectively: Caucasian (75% vs. 43%), Asian (12% vs. 35%), Native Hawaiian/Pacific Islander (NHPI) (9% vs. 13%), and other (4% vs. 9%) (p < 0.001). No fractures, dislocations, or revisions occurred within 1 year after surgery in either group. One deep infection was noted in the SO group. The proportions of patients following surgery who had a GHOD < 6 mm (76% vs. 82%; p = 0.193) and LLD < 6 mm (81% vs. 86%; p = 0.223) were not significantly different between EO and SO groups, respectively. CONCLUSIONS Prioritizing hip symmetry over stability results in a high proportion of patients achieving hip symmetry without high usage of EO stems in AA THA. Furthermore, low use of EO stems did not result in increased dislocations. Due to racial anatomical differences, Caucasian patients required EO stems to achieve hip symmetry more frequently than Asian and NHPI patients.
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Affiliation(s)
- Edward Weldon
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Keinan Agonias
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - James DeJesus
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA
| | - Rosana Hernandez Weldon
- University of Hawaii at Manoa, Office of Public Health Studies, 1960 East-West Road, Honolulu, HI, 96822, USA
| | - Donna Lyn M T Au
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA
| | - Cass K Nakasone
- John A Burns School of Medicine, University of Hawaii at Manoa, 651 Ilalo Street, Honolulu, HI, 96813, USA.
- Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96813, USA.
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Boyle AB, Kuperus T, Maheno T, Frampton C, Vane A, Poutawera V. Equivalent revision rates and patient reported outcomes with routine use of a short (125mm) cemented stem for total hip arthroplasty compared to a standard length (150mm) cemented stem. A two surgeon series of 1335 patients. Arch Orthop Trauma Surg 2024; 144:2019-2026. [PMID: 38581441 DOI: 10.1007/s00402-024-05235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/15/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Routine total hip arthroplasty (THA) using a short cemented stem as compared with a standard length cemented stem may have benefits in terms of stress distribution, bone preservation, stem subsidence and ease of revision surgery. Two senior arthroplasty surgeons transitioned their routine femoral implant from a standard 150 mm Exeter V40 cemented stem to a short 125 mm Exeter V40 cemented stem for all patients over the course of several years. We analysed revision rates, adjusted survival, and PROMS scores for patients who received a standard stem and a short stem in routine THA. METHODS All THAs performed by the two surgeons between January 2011 and December 2021 were included. All procedures were performed using either a 150 mm or 125 mm Exeter V40 stem. Demographic data, acetabular implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the New Zealand Joint Registry (NZJR), and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were also recorded. RESULTS 1335 THAs were included. 516 using the 150 mm stem and 819 using the 125 mm stem. There were 4055.5 and 3227.8 component years analysed in the standard stem and short stem groups respectively due to a longer mean follow up in the 150 mm group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the standard 150 mm stem (0.44 revisions/100 component years) and the short 125 mm stem (0.56 revisions/100 component years) with no statistically significant difference found (p = 0.240). CONCLUSION Routine use of a short 125 mm stem had no statistically significant impact on revision rate or PROMS scores when compared to a standard 150 mm stem. There may be benefits to routine use of a short cemented femoral implant.
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Affiliation(s)
- Alex B Boyle
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, Private Bag 12024, Tauranga, 3143, New Zealand.
| | - Tom Kuperus
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, Private Bag 12024, Tauranga, 3143, New Zealand
| | - Teriana Maheno
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, Private Bag 12024, Tauranga, 3143, New Zealand
| | - Chris Frampton
- Department of Medicine, The University of Otago, Christchurch, New Zealand
| | - Andrew Vane
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, Private Bag 12024, Tauranga, 3143, New Zealand
| | - Vaughan Poutawera
- Department of Orthopaedic Surgery, Tauranga Hospital, Bay of Plenty, Private Bag 12024, Tauranga, 3143, New Zealand
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Xiong HZ, Xiang K, Liu XQ, Jin Y, Zhong HH, Wu SH, Peng JC. Clinical outcomes following direct anterior approach during total hip arthroplasty without hip extension: a retrospective comparative study. BMC Musculoskelet Disord 2024; 25:276. [PMID: 38600475 PMCID: PMC11005236 DOI: 10.1186/s12891-024-07416-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/04/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Traditional total hip arthroplasty (THA) using the direct anterior approach (DAA) requires a hip extension. This study aimed to compare the clinical outcomes of patients undergoing THA with DAA using either the no hip extension (NHE) or the traditional hip extension (THE) strategy. METHODS A retrospective analysis of demographics, clinical and radiological outcomes, and occurrence of complications was performed using data from 123 patients treated between January 2020 and November 2021. The patients were categorised into two groups: NHE (84 patients) and THE (39 patients). RESULTS The NHE group exhibited shorter operative time and had more male participants with higher ages. Comparable outcomes were observed in the visual analogue scale, Harris Hip, and Oxford Hip scores at the final follow-up. Furthermore, complications were observed in the NHE and THE groups, including two and one greater trochanteric fractures and three and one transfusions, respectively. CONCLUSIONS Compared to the THE, employing the NHE strategy during THA with DAA in elderly and young female patients resulted in comparable clinical outcomes with several advantages, such as favourable surgical time. The NHE method also exhibited good safety and effectiveness. Therefore, the NHE strategy may be a favourable option for elderly and young female patients.
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Affiliation(s)
- Hua-Zhang Xiong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Kuan Xiang
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Xiu-Qi Liu
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Ying Jin
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - He-He Zhong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Shu-Hong Wu
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Jia-Chen Peng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China.
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Mancino F, Fontalis A, Magan A, Plastow R, Haddad FS. The Value of Computed Tomography Scan in Three-dimensional Planning and Intraoperative Navigation in Primary Total Hip Arthroplasty. Hip Pelvis 2024; 36:26-36. [PMID: 38420736 DOI: 10.5371/hp.2024.36.1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/24/2023] [Accepted: 08/10/2023] [Indexed: 03/02/2024] Open
Abstract
Total hip arthroplasty (THA) is a frequently performed procedure; the objective is restoration of native hip biomechanics and achieving functional range of motion (ROM) through precise positioning of the prosthetic components. Advanced three-dimensional (3D) imaging and computed tomography (CT)-based navigation are valuable tools in both the preoperative planning and intraoperative execution. The aim of this study is to provide a thorough overview on the applications of CT scans in both the preoperative and intraoperative settings of primary THA. Preoperative planning using CT-based 3D imaging enables greater accuracy in prediction of implant sizes, leading to enhancement of surgical workflow with optimization of implant inventory. Surgeons can perform a more thorough assessment of posterior and anterior acetabular wall coverage, acetabular osteophytes, anatomical landmarks, and thus achieve more functional implant positioning. Intraoperative CT-based navigation can facilitate precise execution of the preoperative plan, to attain optimal positioning of the prosthetic components to avoid impingement. Medial reaming can be minimized preserving native bone stock, which can enable restoration of femoral, acetabular, and combined offsets. In addition, it is associated with greater accuracy in leg length adjustment, a critical factor in patients' postoperative satisfaction. Despite the higher costs and radiation exposure, which currently limits its widespread adoption, it offers many benefits, and the increasing interest in robotic surgery has facilitated its integration into routine practice. Conducting additional research on ultra-low-dose CT scans and examining the potential for translation of 3D imaging into improved clinical outcomes will be necessary to warrant its expanded application.
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Affiliation(s)
- Fabio Mancino
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Andreas Fontalis
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ahmed Magan
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Ricci Plastow
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, United Kingdom
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Dubin JA, Westrich GH. Less groin pain with dual-mobility bearings versus fixed bearings in total hip arthroplasty. Hip Int 2024; 34:15-20. [PMID: 36891584 DOI: 10.1177/11207000231158722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
INTRODUCTION The relationship between implant type, dual mobility (DM) or fixed bearing (FB), and postoperative groin pain remains unexplored. We examined the incidence of groin pain in DM implants and compare this to a cohort of FB THA patients. METHODS From 2006 to 2018, a single surgeon performed 875 DM THA and 856 FB THA procedures with 2.8-year and 3.1-year follow-up, respectively. Each patient received a questionnaire postoperatively and was asked if they had any groin pain (yes/no). Secondary measurements were implant characteristics such as head size, head offset, cup size, and cup-to-head ratio. Additional PROMs that were collected included: Veterans RAND 12 (VR-12), University of California Los Angeles (UCLA) activity score, Pain visual analogue scale (Pain VAS), and range of motion (ROM). RESULTS The incidence of groin pain was 2.3% in the DM THA cohort and 6.3% in the FB THA group (p < 0.001). Also, low head offset (⩽0 mm) had a significant odds ratio (1.61) for groin pain in both cohorts. There was no significant difference in terms of revision rate between the cohorts (2.5% vs. 3.3%, p = 0.39) at the latest follow up. CONCLUSIONS This study demonstrated a lower incidence of groin pain (2.3%) in patients with a DM bearing compared to a FB (6.3%) and a greater risk of groin pain with low head offset (<0 mm). As such, surgeons should try to recreate offset of the hip compared to the contralateral side to avoid groin pain.
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Affiliation(s)
- Jeremy A Dubin
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
| | - Geoffrey H Westrich
- Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY, USA
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Shah HN, Barrett AA, Finlay AK, Arora P, Bellino MJ, Bishop JA, Gardner MJ, Miller MD, Huddleston JI, Maloney WJ, Goodman SB, Amanatullah DF. Arthroplasty for femoral neck fractures is at risk for under restoration of lateral femoral offset. Hip Int 2024; 34:134-143. [PMID: 37128124 DOI: 10.1177/11207000231169914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of the study was to determine the restoration of hip biomechanics through lateral offset, leg length, and acetabular component position when comparing non-arthroplasty surgeons (NAS) to elective arthroplasty surgeons (EAS). METHODS 131 patients, with a femoral neck fracture treated with a THA by 7 EAS and 20 NAS, were retrospectively reviewed. 2 blinded observers measured leg-length discrepancy, femoral offset, and acetabular component position. Multivariate logistic regression models examined the association between the surgeon groups and restoration of lateral femoral, acetabular offset, leg length discrepancy, acetabular anteversion, acetabular position, and component size, while adjusting for surgical approach and spinal pathology. RESULTS NAS under-restored 4.8 mm of lateral femoral offset (43.9 ± 8.7 mm) after THA when compared to the uninjured side (48.7 ± 7.1 mm, p = 0.044). NAS were at risk for under-restoring lateral femoral offset when compared to EAS (p = 0.040). There was no association between lateral acetabular offset, leg length, acetabular position, or component size and surgeon type. CONCLUSIONS Lateral femoral offset is at risk for under-restoration after THA for femoral neck fractures, when performed by surgeons that do not regularly perform elective THA. This indicates that lateral femoral offset is an under-appreciated contributor to hip instability when performing THA for a femoral neck fracture. Lateral femoral offset deserves as much attention and awareness as acetabular component position since a secondary analysis of our data reveal that preoperative templating and intraoperative imaging did not prevent under-restoration.
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Affiliation(s)
- Harsh N Shah
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Andrew A Barrett
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Andrea K Finlay
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Prerna Arora
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Michael J Bellino
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Julius A Bishop
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Michael J Gardner
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Matthew D Miller
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - James I Huddleston
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - William J Maloney
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
| | - Stuart B Goodman
- Department of Orthopaedic Surgery, Stanford Medicine, Redwood City, CA, USA
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Xiong HZ, Yang LD, Bao G, Peng JC, Liu ZH. Improved surgical exposure and early clinical outcomes using a femoral-release-first technique in direct anterior approach during total hip arthroplasty. J Orthop Surg Res 2023; 18:878. [PMID: 37980499 PMCID: PMC10656993 DOI: 10.1186/s13018-023-04334-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) performed using the direct anterior approach (DAA) has demonstrated favourable early-, mid-, and long-term outcomes. However, the traditional femoral release technique remains technically demanding and is associated with challenges and a heightened risk of complications. This study aimed to compare the clinical outcomes of patients who underwent THA with DAA performed using either the femoral-release-first (FRF) or the traditional approach (TA) strategy. METHODS A retrospective analysis of demographics, clinical and radiological outcomes, and occurrence of complications was performed using data from 106 patients between 2018 and 2019. The patients were categorised into two groups: FRF (44 hips) and TA (69 hips). RESULTS The FRF group showed a reduced operative time, haemoglobin (Hb) drop, postoperative hospital stay, and more optimal acetabular cup anteversion angles. Furthermore, during the first 2 months postoperatively, the FRF group demonstrated superior visual analogue scale, Harris Hip, and Oxford Hip scores. In the TA group, two hips experienced greater trochanter fractures, and one experienced delayed incision healing. CONCLUSIONS Compared with the TA, employing the FRF strategy during THA with DAA resulted in improved outcomes within the first 2 months postoperatively and comparable functional recovery beyond this period. The FRF method exhibited advantages such as favourable acetabular exposure and alignment and a reduced risk of complications. Therefore, the FRF strategy may be a favourable option.
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Affiliation(s)
- Hua-Zhang Xiong
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Li-Dan Yang
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China
| | - Gang Bao
- Department of Orthopedic Surgery, People's Hospital of Yinjiang Tujia and Miao Autonomous County, 52# Xiyuan Road, Yinjiang, 555200, People's Republic of China
| | - Jia-Chen Peng
- Department of Orthopedic Surgery, Affiliated Hospital of Zunyi Medical University, 149# Dalian Road, Zunyi, 563003, People's Republic of China.
| | - Zhi-Hong Liu
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197# Ruijin Second Road, Shanghai, 200025, People's Republic of China.
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Jiawei L, Kai Z, Haiyan W, Chao W, Yunfeng Z, Liangjia D, Qinghua L, Canran L, Feng J, Xiaohe L. Digital measurement and clinical significance of proximal femur in the older people of Inner Mongolia population, China. BMC Geriatr 2023; 23:632. [PMID: 37803256 PMCID: PMC10559419 DOI: 10.1186/s12877-023-04254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/24/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE This study aimed to measure the parameters of the proximal femur in the older people of Inner Mongolia, China and understand the influence of age and gender so as to provide guidance for the design and improvement of prosthesis for total hip arthroplasty. METHODS A total of 236 patients who underwent CT angiography of lower limbs in the Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University of China were collected. They were divided into 4 groups according to age: < 60 (group A), 60-69 (group B), 70-79 (group C), and > 80 years (group D). Four anatomical parameters, including femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion (FNA), were measured by Mimics 21.0. Comparisons were made between age groups of the same gender and between genders in the same age group to analyze the correlation of the 4 parameters of proximal femur with age and gender. In addition, the results of this study were compared with previous studies. RESULTS There were no significant differences in FHD and FO between age groups, indicating no correlation with age. FNSA and FNA were no significantly different between group C and group D in the same gender, whereas there were significant differences between other age groups and were negatively correlated with age. There were significant differences in FHD and FO between genders in the same age group, with the males being larger than the females. FNSA and FNA were no significant differences between genders in the same age group. CONCLUSIONS FNSA and FNA decrease with age. FHD and FO were larger in males than in females in all age groups. Age and gender should be considered in the design of prosthesis.
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Affiliation(s)
- Li Jiawei
- Department of Imaging, The Second Affiliated Hospital of Baotou Medical College, Baotou, 014030, Inner Mongolia Autonomous Region, China
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Kai
- Department of Orthopedics, The Second People's Hospital of Ulanqab, Ulanqab, 012000, Inner Mongolia Autonomous Region, China.
| | - Wang Haiyan
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Wu Chao
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Yunfeng
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Ding Liangjia
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Liu Qinghua
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Canran
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Jin Feng
- Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Xiaohe
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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Patel A, Guntin J, Sobh A, Gerlinger TL. Offset Acetabular Liners: Safer Than Previously Thought. Orthopedics 2023; 46:e298-e302. [PMID: 36921222 DOI: 10.3928/01477447-20230310-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
High offset liners help to restore soft tissue tension after primary total hip arthroplasty (THA). However, prior research has reported increased rates of aseptic loosening when using offset components. The purpose of this study was to examine the postoperative complication and revision rates of neutral vs offset acetabular liners at our institution. Two hundred eight primary THAs in 206 patients performed between 2016 and 2018 using neutral or offset liners were reviewed. All patients had a minimum 2-year clinical follow-up (mean, 3.3 years; range, 2.0-5.7 years). Postoperative complications and revision surgeries were reviewed. All offset liners were 4 mm in thickness. Twelve (10.0%) complications occurred in the neutral liner group, and 13 (14.8%) complications occurred in the offset liner group. Two cases of aseptic loosening occurred in the neutral liner group, with no cases reported in the offset liner group. Nine cases (7.5%) in the neutral group required revision surgery, whereas 3 cases in the offset group required revision surgery. Chi-square analysis found no difference between the groups in the rate of postoperative complications, χ2 (1, N=208)=1.09 (P>.05), or the rate of revision, χ2 (1, N=208)=1.56 (P>.05). We found no significant differences between the neutral and offset groups regarding the rates of postoperative complications, aseptic loosening, or revision surgery. Our findings suggest that contemporary high offset liners, up to 4 mm, are safe and effective when attempting to restore native hip mechanics after THA. [Orthopedics. 2023;46(5):e298-e302.].
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Saunders P, Shaw D, Sidharthan S, Young SK, Board T. Hip offset and leg-length restoration in revision hip arthroplasty with a monoblock, hydroxyapatite-coated stem. Hip Int 2023; 33:880-888. [PMID: 35993222 DOI: 10.1177/11207000221117782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Restoration of normal hip biomechanics in arthroplasty surgery is important in order to achieve good muscle function and joint stability. METHODS In this retrospective cohort study, we examined the postoperative radiographs of 131 femoral revision arthroplasty procedures using a monoblock, fully hydroxyapatite (HA)-coated titanium stem. Femoral offset, modified-global offset and leg length were measured of the operated and contralateral hips. RESULTS Femoral offset was restored to ±10 mm in 108 cases (82%), modified-global offset was restored ±10 mm in 93 cases (71%) and leg length was restored to ±10 mm in 102 cases (81%). There were 4 dislocations with a mean follow-up period of 38 months. CONCLUSIONS Restoration of hip biomechanics is achievable with a monoblock stem and thus is a viable option in revision hip arthroplasty.
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Affiliation(s)
- Paul Saunders
- Department of Orthopaedics, Warwick Hospital, Warwick, UK
| | - Debbie Shaw
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - Sijin Sidharthan
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | | | - Tim Board
- Wrightington Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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12
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Gaston P, Clement ND, Ohly NE, Macpherson GJ, Hamilton DF. Can Arthroplasty Stem Influence Outcome: A Randomized Controlled Trial of Stem Length in Cemented Total Hip Arthroplasty. J Arthroplasty 2023; 38:1793-1801. [PMID: 36813218 DOI: 10.1016/j.arth.2023.02.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND The primary aim was to assess whether a short (125 millimeter (mm)) stem offered an equivalent hip-specific function compared to the standard (150 mm) stem when used for cemented total hip arthroplasty. Secondary aims were to evaluate health-related quality of life, patient satisfaction, stem height and alignment, as well as radiographic loosenings and complications between the two stems. METHODS A prospective twin-center double-blind randomized control trial was conducted. During a 15-month period, 220 patients undergoing total hip arthroplasty were randomized to either a standard (n = 110) or a short (n = 110) stem. There were no significant (P ≥ .065) differences in preoperative variables between the groups. Functional outcomes and radiographic assessment were undertaken at a mean of 1 and 2 years. RESULTS There were no differences (P = .428) in hip-specific function according to the mean Oxford hip scores at 1 year (primary endpoint) or at 2 years (P = .622) between the groups. The short stem group had greater varus angulation (0.9 degrees, P = .003) when compared to the standard group and were more likely (odds ratio 2.42, P = .002) to have varus stem alignment beyond one standard deviation from the mean. There were no significant (P ≥ .083) differences in the forgotten joint scores, EuroQol-5-Dimension, EuroQol-visual analogue scale, short form 12, patient satisfaction, complications, stem height, or radiolucent zones at 1 or 2 years between the groups. CONCLUSION The cemented short stem used in this study had equivalent hip-specific function, health-related quality of life, and patient satisfaction when compared to the standard stem at mean 2 years post operation. However, the short stem was associated with a greater rate of varus malalignment, which may influence future implant survival.
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Affiliation(s)
- Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh; Department of Orthopaedics, University of Edinburgh, Edinburgh
| | - Nicholas D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh; Department of Orthopaedics, University of Edinburgh, Edinburgh
| | | | - Gavin J Macpherson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh; Department of Orthopaedics, University of Edinburgh, Edinburgh
| | - David F Hamilton
- Department of Orthopaedics, University of Edinburgh, Edinburgh; School of Health and Life Sciences, Glasgow Caledonian University, Glasgow
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13
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Luca DiGiovanni P, Gasparutto X, Armand S, Hannouche D. The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review. EFORT Open Rev 2023; 8:117-126. [PMID: 36916758 PMCID: PMC10026057 DOI: 10.1530/eor-22-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Offsets in the frontal plane are important for hip function. Research on total hip arthroplasty (THA) surgery agrees that increasing femoral offset up to 5 mm could improve functional outcome measures. The literature indicates that global offset is a key parameter that physicians should restore within 5 mm during surgery and avoid decreasing. Substantiated findings on acetabular offset are lacking despite its recognized importance, and the medialization approach must be assessed in light of its shortcomings. Future research, possibly through improved measurement, unified definitions, patient-specific surgical planning, and technology-enhanced surgical control, with specific focus on acetabular offset, is needed to better understand its impact on THA outcomes.
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Affiliation(s)
- Peter Luca DiGiovanni
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Xavier Gasparutto
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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14
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Bullen ME, Babazadeh S, van Bavel D, McKenzie DP, Dowsey MM, Choong PF. Reduction in Offset Is Associated With Worse Functional Outcomes Following Total Hip Arthroplasty. J Arthroplasty 2023; 38:329-334. [PMID: 36096271 DOI: 10.1016/j.arth.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Conflicting reports exist about the effect of offset variation on functional outcomes following total hip arthroplasty. Reproducing native hip offset is thought to optimize function by restoring biomechanics and appropriately tensioning the hip abductor muscles. The aim of this study is to assess the effect of failing to restore global hip offset in comparison to the native contralateral hip. METHODS A retrospective analysis of a prospective patient cohort was performed on patients undergoing an elective primary total hip arthroplasty. A total of 414 patients who had a minimum of 12 months of follow-up were included. Postoperative plain radiographs were analyzed for offset and compared to the contralateral native hip. Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Veterans RAND 12 (VR-12) scores were assessed preoperatively and at 12 months postoperatively. RESULTS Regression analyses indicated that a reduction in offset of >20 mm resulted in worse WOMAC pain (P = .005) and motion (P = .015) scores compared to those with maintained offset. WOMAC function (P = .063), global (P = .025), and VR-12 scores were not affected (physical P = .656; mental P = .815). Reduction in offset up to 20 mm and increased offset were not significantly associated with patient-reported outcome measures (P-values ranged from .102 to .995). CONCLUSION This study demonstrated an association between reduction in offset by >20 mm and worse WOMAC pain and motion scores following total hip arthroplasty. Surgeons should avoid decreases in offset >20 mm in order to optimize functional outcomes.
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Affiliation(s)
- Michael E Bullen
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Sina Babazadeh
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Dirk van Bavel
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia
| | - Dean P McKenzie
- Department of Epidemiology and Preventive Medicine, Epworth HealthCare, Monash University, Melbourne, Australia
| | - Michelle M Dowsey
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia; University of Melbourne Department of Surgery at St. Vincent's Hospital Melbourne, Level 2 Clinical Sciences Building, Fitzroy, Australia
| | - Peter F Choong
- Department of Othopaedics at St. Vincent's Hospital Melbourne, Level 3 Daly Wing, Fitzroy, Australia; University of Melbourne Department of Surgery at St. Vincent's Hospital Melbourne, Level 2 Clinical Sciences Building, Fitzroy, Australia
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15
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Assessing Leg Length and Offset in Anterior Total Hip Arthroplasty: Overlay Versus AP Pelvis Intraoperative Radiographic Techniques: A Retrospective Cohort Study. J Am Acad Orthop Surg 2023; 31:106-113. [PMID: 36580052 DOI: 10.5435/jaaos-d-22-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 08/06/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Two intraoperative radiographic techniques to determine leg length and offset during anterior total hip arthroplasty (THA) are the AP pelvis and overlay techniques. The AP pelvis method measures LLDs and offset using AP fluoroscopic images, whereas the overlay method uses printed images of the native and replaced hips. The purpose of this study was to compare these techniques regarding clinical and radiographic LLD and offset discrepancies. METHODS Patients of a single surgeon at two hospitals from September 2017 to January 2021 were retrospectively reviewed. Clinically detectable LLD was recorded. Radiographic measurements were obtained from preoperative and postoperative radiographs. LLD was determined based on the vertical distance between the lesser trochanters and the ischial tuberosities. Total offset was measured using a combination of femoral and medial offset. The Student t-test, Fisher exact test, and Wilcoxon rank sum tests were used for statistical analysis. RESULTS Seventy-one procedures were done using the overlay technique and 61 used for the AP pelvis technique. No significant differences were observed in mean postoperative LLD (2.66 versus 2.88 mm, P = 0.66) and mean postoperative offset discrepancy (5.37 versus 4.21 mm, P = 0.143) between the overlay versus AP pelvis groups. The mean preoperative to postoperative absolute difference in offset was less than 5 mm in both groups. Clinically detectable LLD was noted in six of 71 patients in the overlay group and one of 61 in the AP pelvis group (P = 0.123). CONCLUSION No notable differences were observed in intraoperative leg length and offset discrepancies during direct anterior THA between the AP pelvis and overlay techniques, suggesting they are equally effective in determining LLD and offset intraoperatively. The choice of technique to use anterior THA should be based primarily on the surgeon's preference, comfort, and available resources.
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16
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Hu H, Lin M, Wu X, Lin Y, Lin Y, Chen G. Intraoperative method of femoral head central measurement to prevent leg length discrepancy following hemiarthroplasty. Front Surg 2023; 9:1055199. [PMID: 36684157 PMCID: PMC9859662 DOI: 10.3389/fsurg.2022.1055199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023] Open
Abstract
Purpose This study aimed to introduce and investigate the safety and efficiency of the intraoperative central measurement method of the femoral head (IM-CMFH) to prevent leg length discrepancies (LLD) after hemiarthroplasty. Methods Overall, 79 patients aged 75 to 85 years with femoral neck fractures who underwent hemiarthroplasty were divided into two groups: the Control group (n = 46) and the IM-CMFH group (n = 33). The two groups were compared for postoperative LLD and the proportions of patients with greater than 10 mm, 6-10 mm, and within 5 mm, postoperative femoral offset (FO) difference and the proportions of patients within 5 mm, incremental greater than 5 mm and reduction greater than 5 mm. Next, the vertical distance from the center of the femoral head to the tip of the greater trochanter on the anatomical axis of the femur (VD-CFH-TGTAAF), leg length, and FO on the operative and non-operative sides within the IM-CMFH group. Finally, operative time, hemoglobin loss, Harris scores 3 months after surgery, and postoperative complications were analyzed. Results Compared with the control group, the postoperative LLD and FO differences were significantly lower in the IM-CMFH group (P = 0.031; P = 0.012), and the proportion of patients with postoperative LLD greater than 10 mm decreased significantly (P = 0.041), while the proportion of patients with FO difference of within 5 mm increased (P = 0.009). In addition, there was no significant difference in the operative time, hemoglobin loss, and Harris score at 3 months postoperatively and postoperative complications between the two groups (P > 0.05). There was no significant difference in FO, leg-length, and VD-CFH-TGTAAF between the operative and non-operative sides within the IM-CMFH group (P > 0.05). Conclusion Satisfactory results can be achieved by using the IM-CMFH to prevent LLD following hemiarthroplasty, and there is no increase in operative time, hemoglobin loss, or postoperative complications. This technique is efficient for hemiarthroplasties and is both simple and convenient.
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Affiliation(s)
- Hongxin Hu
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China,The Third Clinical Medical College of Fujian Medical University, Putian, China
| | - Mei Lin
- The Third Clinical Medical College of Fujian Medical University, Putian, China,Department of Surgery, Affiliated Hospital of Putian University, Putian, China
| | - Xianwei Wu
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China,The Third Clinical Medical College of Fujian Medical University, Putian, China
| | - Yujin Lin
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China,The Third Clinical Medical College of Fujian Medical University, Putian, China
| | - Yijun Lin
- The Third Clinical Medical College of Fujian Medical University, Putian, China,Department of Radiology and Imaging, Affiliated Hospital of Putian University, Putian, China
| | - Guoli Chen
- Department of Orthopaedics, Affiliated Hospital of Putian University, Putian, China,The Third Clinical Medical College of Fujian Medical University, Putian, China,Correspondence: Guoli Chen
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17
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Tian Z, Mao X, Gao Z, Chen B, Wang Z, Yin Z, Guo Z, Gao Z, Xiang C. A simple method for restoring the femoral head center in hip arthroplasty: a 3-dimensional analysis in the Chinese population. BMC Musculoskelet Disord 2022; 23:986. [PMID: 36380305 PMCID: PMC9664741 DOI: 10.1186/s12891-022-05901-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Various authors have successfully demonstrated that the distance from the greater trochanter to the femoral head center (GTFHC) and the distance from the lesser trochanter to the femoral head center (LTFHC) can be used as parameters to determine the recovery of the femoral head center (FHC) during hip arthroplasty. It is necessary to undertake an anatomical study concerning the correlations between the greater trochanter (GT), the lesser trochanter (LT), and the FHC using data obtained from the 3D-CT reconstruction method. Methods The study comprised 293 patients (151 males and 142 females), with an average age of 65.06 years. The femoral head diameter(FHD), the linear distance from FHC to GT (GTFHC), and the linear distance from FHC to LT(LTFHC) were all measured and recorded data. The correlation between FHD with LTFHC and GTFHC was assessed using Pearson correlation coefficients, and the ratio of LTFHC and GTFHC to FHD was calculated from this ratio. All measured parameters were compared between the left and right sides and the sexes of the participants. Results The average ratios of GTFHC/FHD and LTFHC/FHD were 0.99 and 0.95, respectively .96% of the LTFHC had absolute lateral differences of < 4 mm . 92% of the GTFHC had absolute lateral differences of < 4 mm. Conclusion LTFHC and GTFHC are reliable reference parameters for preoperative planning and reconstruction of FHC of hip arthroplasty. The ratio displayed in this research may yield insight into a practical and straightforward method for orthopedic surgeons to perform hip arthroplasty in patients with femoral neck fractures. Ratios from studies based on the same race may be desirable for future work.
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18
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Sun J, Zhang Y, Shen J, Zheng Q, Li T, Zhang B, Zhou Y, Zhang G. Comparison of Preoperative Computed Tomography and Intraoperative Estimation in Predicting the Version of a Single-Wedge Femoral Stem. Orthop Surg 2022; 14:2979-2986. [PMID: 36177805 PMCID: PMC9627059 DOI: 10.1111/os.13524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 08/27/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Early prediction of stem version aids in optimization of combined version during total hip arthroplasty (THA). This study aimed to analyze the discrepancy between stem version and native femoral version measured by different methods, and to explore which method can better predict the stem version. Methods We retrospectively reviewed 26 patients (39 hips) treated with robot‐assisted THA in our hospital between September 2019 and December 2019. A straight, single‐wedge, cementless stem (Accolade II) was used in all cases. Preoperative femoral version was measured at three levels on computerized tomography (CT) scan from the top to the middle level of femoral neck (Level 1 to Level 3). During THA, the version on cutting surface was measured prior to femoral broaching based on two reference lines: mid‐cortical line and T line (trochanteric fossa to the middle of medial cortex). After femoral broaching, stem version was measured based on the femoral neck trial using Mako system (Stryker). In the statistical analysis, the difference and absolute discrepancy between stem version and femoral version measured with various methods were examined using paired t‐test, and the relationship between stem version and various femoral versions were examined using correlation analysis. Results Mean femoral neck version (Level 1) was 9.5° ± 2.6° (range, −16.8°‐42.5°), while mean stem version measured by Mako system was 19.9° ± 2.0° (range, −8.0°‐49.0°). Femoral version measured with each method showed a moderate correlation with stem version (p < 0.05). There was a significant difference between stem version and femoral version except at Level 3, with a mean difference of 0.8° ± 13.6° (p = 0.729). With regard to the intraoperative estimation, stem version significantly increased compared to the value based on mid‐cortical line, with a mean difference of 8.4° ± 13.1° (p < 0.001). However, the mean value of stem version was a little smaller than that of femoral version measured by reference to T line, but without statistical significance (p = 0.156). No postoperative dislocations occurred during the study period. No revision was required for any component. Conclusions The middle level of femoral neck on CT scan and T line on cutting surface are better references to measure femoral version for predicting postoperative stem version. However, the relationship between stem version and predictive value was flexible. Therefore, further three‐dimensional studies of postoperative CT are needed to validate the press‐fit fixation and rotational freedom of the single‐wedge stem.
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Affiliation(s)
- Jingyang Sun
- Medical School of Chinese PLA, Beijing, China.,Orthopaedics Department, Peking University Shougang Hospital, Beijing, China
| | - Yanchao Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Junmin Shen
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qingyuan Zheng
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Bohan Zhang
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China
| | - Yonggang Zhou
- Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Guoqiang Zhang
- Department of Orthopaedics, The First Medical Center of PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Fourth Medical Center of PLA General Hospital, National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
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19
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Influence of implantation of a total hip endoprosthesis on the ipsilateral leg alignment: the effect of sex and dysplasia of the hip. Arch Orthop Trauma Surg 2022; 143:3541-3549. [PMID: 36001169 DOI: 10.1007/s00402-022-04587-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Differences in leg and hip morphology exist between sexes and developmental hip dysplasia is known to alter proximal femoral morphology. The purpose of this study was to determine whether existing differences in leg alignment due to sex or developmental hip dysplasia have an effect on changes in leg alignment after total hip arthroplasty. MATERIALS AND METHODS 30 hip osteoarthritis patients underwent biplanar full-length radiography in the standing position preoperatively and 3 months after total hip arthroplasty. Differences in leg alignment between men and women and between patients with primary hip osteoarthritis and patients with developmental dysplasia before and after surgery were tested using a general linear model for repeated measures. RESULTS Implantation of a hip prosthesis had no differential effect on ipsilateral leg alignment in patients with hip osteoarthritis due to dysplasia and in patients with primary hip osteoarthritis. However, patients with hip osteoarthritis due to dysplasia had a 2.1° higher valgus both before and after surgery. After total hip arthroplasty, women had a significantly greater increase in varus angle (1.6° vs. 0°) and femoral offset (10.5 vs. 4.6 mm) compared with men. Because the change in acetabular offset was smaller (2.2 vs. 6.2 mm), the global femoral offset was only increased in women. Femoral torsion was constant for men (15.0° and 16.5°), whereas femoral torsion was significantly reduced in women (19.9° and 13.2°). CONCLUSIONS Hip arthroplasty has a greater effect on leg axis in women than in men. The axial leg alignment of women could change from a natural valgus to a varus alignment. Therefore, surgeons should consider the effects of total hip arthroplasty on leg alignment in patients with hip osteoarthritis. Whether these changes in leg alignment are also clinically relevant and lead to premature medial or lateral knee osteoarthritis should be investigated in future work. TRIAL REGISTRATION This study was registered with DRKS (German Clinical Trials Register) under the number DRKS00015053. Registered 1st of August 2018.
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20
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Stewart NJ, Stewart JL, Brisbin A. A Comparison of Component Positioning Between Fluoroscopy-Assisted and Robotic-Assisted Total Hip Arthroplasty. J Arthroplasty 2022; 37:1602-1605.e3. [PMID: 35314287 DOI: 10.1016/j.arth.2022.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This single-surgeon retrospective study examined a consecutive series of direct anterior approach total hip arthroplasties (THAs). Differences for the accuracy of acetabular component placement, leg length discrepancy, femoral offset, and absolute global offset difference were measured for patients who underwent hip replacement surgery with either fluoroscopic or robotic guidance. METHODS One hundred THAs were included in both the fluoroscopically guided and robotically guided groups in the study. The program TraumaCad was used to analyze the preoperative and 6-week postoperative standing anteroposterior pelvic radiographs used in this study to evaluate the accuracy of component positioning. RESULTS Robotic-guided surgery demonstrated a small improvement in acetabular inclination error, 3.8° average robotic error vs 4.63° average fluoroscopic error (P < .01). There was no statistically significant difference in accuracy for acetabular anteversion, leg length discrepancy, femoral offset, or global offset difference between the 2 groups. There was also no significant difference in the placement of acetabular components into the Lewinnek safe zone or Callanan safe zone. Both fluoroscopically guided and robotically guided THA patients had similar patterns of error, with excessive anteversion and inclination being more common than inadequate anteversion or inclination. CONCLUSION The findings from our study question the use of haptic robotic guidance during direct anterior approach THA when compared to fluoroscopic guidance.
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Affiliation(s)
| | - James L Stewart
- Chippewa Valley Orthopedics and Sports Medicine, Altoona, Wisconsin
| | - Abra Brisbin
- Department of Mathematics, University of Wisconsin Eau Claire, Eau Claire, Wisconsin
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21
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Comparison between two- and three-dimensional methods for offset measurements after total hip arthroplasty. Sci Rep 2022; 12:12644. [PMID: 35879390 PMCID: PMC9314396 DOI: 10.1038/s41598-022-16952-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to compare acetabular offset, femoral offset, and global offset measurements obtained after total hip arthroplasty (THA) between a two-dimensional (2D) method and a three-dimensional (3D) method. The subjects were 89 patients with unilateral osteoarthritis who underwent primary THA at our institution. Acetabular, femoral, and global offsets were measured by each of the 2D and 3D methods in native and implanted hips. In native hips, mean acetabular, femoral, and global offsets were 32.4 ± 3.3, 32.7 ± 4.5, 65.1 ± 5.7 mm, respectively, by the 2D method, and 32.3 ± 3.1, 38.1 ± 4.0, 70.4 ± 4.9 mm, respectively, by the 3D method. In implanted hips, mean acetabular, femoral, and global offsets were 27.6 ± 4.1, 33.8 ± 7.8, 61.4 ± 8.5 mm, respectively, by the 2D method, and 27.6 ± 3.9, 41.8 ± 6.2, 69.4 ± 7.2 mm, respectively, by the 3D method. There was significant difference in femoral and global offsets between the 2D and 3D methods in both native and implanted hips. Comparison of the 2D and 3D methods for evaluation of acetabular, femoral, and global offsets after THA clarified the usefulness and accuracy of the 3D method.
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22
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Hussain S, Malik SS, Budair B, Prakash D. Anatomic placement of the acetabular implant in cementless total hip arthroplasty does not adversely affect the implant survival and patient satisfaction. J Clin Orthop Trauma 2022; 31:101927. [PMID: 35799882 PMCID: PMC9253899 DOI: 10.1016/j.jcot.2022.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 06/09/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate if the acetabulum's conservative reaming with preservation of the medial acetabular bone and anatomic placement of the acetabular implant in cementless total hip arthroplasty (THA) has any adverse effect on the radiological outcome, long term implant survival and patient satisfaction. METHODS 106 consecutive patients were identified from a single surgeon practice who underwent cementless THA from 2005 to 2010. Twenty-one were lost to follow up, and five patients died unrelated to THA. Eighty patients were available for the study. The mean follow-up was 8.6 years (range 5.7-11.6). The mean age was 61.9 years. Immediate pre- and postoperative radiographs were reviewed to calculate combined offset (Acetabular offset - AO, plus Femoral offset - FO). Implant failure, aseptic loosening, revision surgery, patient satisfaction and complications were assessed on long-term follow-up. RESULTS Acetabular component survival was 100% with no aseptic failure. None of the patients had revision surgery for any cause. The mean difference in the acetabular offset and combined offset postoperatively was within 3 mm. One patient had a dislocation, and one had a prosthetic joint infection (PJI). 95% of the patients in this series would recommend the hip replacement procedure to others, with a mean satisfaction score of 8.7 (range; 1-10). CONCLUSION Conservative acetabular reaming with preservation of medial acetabulum bone with the anatomic placement of the acetabular implant in cementless THA is safe with no adverse effects on implant survival and patient satisfaction. It offers the advantage of preserving the patient's bone stock, which would potentially be of significant advantage to the patient and the surgeon in case of revision arthroplasty.
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Affiliation(s)
- Shakir Hussain
- The Royal Orthopaedic Hospital Birmingham, UK,Corresponding author. Department of Arthroplasty, The Royal Orthopaedic Hospital Bristol Road South, Birmingham, UK.
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Scott CEH, Clement ND, Davis ET, Haddad FS. Modern total hip arthroplasty: peak of perfection or room for improvement? Bone Joint J 2022; 104-B:189-192. [PMID: 35094584 DOI: 10.1302/0301-620x.104b2.bjj-2022-0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Chloe E H Scott
- Royal Infirmary of Edinburgh, Edinburgh, UK.,The Bone & Joint Journal , London, UK.,Bone & Joint Research , London, UK.,University of Edinburgh, Edinburgh, UK
| | | | | | - Fares S Haddad
- The Bone & Joint Journal , London, UK.,University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
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Effectiveness of a patient-specific guide for femoral stem implantation in primary total hip arthroplasty: a randomized control trial. INTERNATIONAL ORTHOPAEDICS 2022; 46:805-814. [PMID: 35088177 DOI: 10.1007/s00264-021-05287-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of the present study was to evaluate the efficacy and feasibility of a novel CT-based patient-specific femoral alignment guide (PSG) as compared with conventional pre-operative planning during THA. METHODS From March 2020 to September 2020, patients receiving unilateral primary THA were enrolled and randomly allocated to the conventional pre-operative planning group and the PSG group. Primary outcomes were radiographic measurements including lower limb length, femoral offset, femoral anteversion and stem varus/valgus angle, and post-operative perception of leg length discrepancy (LLD). Secondary outcomes were surgical time, intra-operative blood loss, total blood loss, visual analogue scale (VAS), and Harris Hip Score (HHS). The occurrence of post-operative complications was also recorded. RESULTS Of the 104 patients screened, 80 cases were enrolled for analysis. The demographics of the two groups were similar. The PSG group illustrated significant improvements (p < 0.001) in lower limb length, femoral offset, femoral anteversion, and stem varus/valgus angle. Patients in the PSG group showed more favourable HHS (p < 0.001) at seven day, four week, andthree month (p = 0.003) follow-up. Perception of LLD was found significantly lower in the PSG group at three tmonth (p = 0.043), six month (p = 0.025), and 12-month (p = 0.048) follow-up. Utilization of the PSG had no significant increase in operative time, intra-operative blood loss, total blood loss, or VAS. No complication was noted in either group. CONCLUSION Relative to conventional pre-operative planning, the application with the PSG could potentially provide a simple and reliable solution for improving femoral prosthesis orientation in THA with high accessibility and low healthcare costs. TRN: ChiCTR2000031043 Date of registration: 2020/3/21.
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Lopes BDM, Spinelli LDF, Galia CR, Schwartsmann CR, Silva MF. INFLUENCE OF FEMORAL OFFSET ON FUNCTIONAL CAPACITY OF PATIENTS WITH TOTAL HIP ARTHROPLASTY. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e243763. [PMID: 35694021 PMCID: PMC9150870 DOI: 10.1590/1413-785220223003e243763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022]
Abstract
Objective To correlate vertical (VFO) and horizontal (HFO) femoral offset with hip range of motion (ROM), peak muscle torque (PT), functional, capacity, and lower limb length in patients with total hip arthroplasty (THA). Methods A cross-sectional case control study, in which 22 individuals (10 men and 12 women) - aged 61 (41-72), and within 23 (10-40) postoperative days - were evaluated for active hip ROM (fleximetry); Isometric PT (portable dynamometer); functional capacity (Timed up and Go test (TUG) and Harris Hip Score questionnaire); lower limb length (measuring tape); and VFO and HFO (radiographs). Results The operated limb showed a reduction in length (p = 0.006), ROM for abduction (p = 0.001), flexion (p = 0.003), and external rotation (p = 0.003), as well as in all PT (p < 0.05) when compared with the contralateral limb. Moderate correlations were observed between VFO and external rotators (r = 0.487; p = 0.021); HFO and external rotators PT (r = -0.508; p = 0.016); and the difference between the VFO (operated and non-operated limb) and the TUG (r = -0.570; p = 0.006). Conclusion Changes to the femoral offset seem to influence functional capacity, as well as the movement and external rotators PT of the hips in patients with THA, considering the postoperative period evaluated. Level of Evidence III, Case Control Study.
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Campbell A, Emara AK, Klika A, Piuzzi NS. Does Implant Selection Affect Patient-Reported Outcome Measures After Primary Total Hip Arthroplasty? J Bone Joint Surg Am 2021; 103:2306-2317. [PMID: 34495897 DOI: 10.2106/jbjs.20.01931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is a reliable operation, but it is critical that orthopaedic surgeons characterize which surgical factors influence patient-reported outcomes. The purpose of this study was to determine whether implant selection at the time of THA affects the odds of having (1) inadequate improvement according to patient-reported pain, function, and activity; (2) failure to achieve a substantial clinical benefit (SCB) with respect to pain; or (3) failure to achieve a patient-acceptable symptomatic state (PASS) according to pain and function. METHODS Prospective data were collected from 4,716 patients who underwent primary THA (from July 2015 to August 2018) in a single health-care system with standardized care pathways. Patients were categorized according to the type of femoral and acetabular components and bearing surface used. Outcomes included 1-year postoperative patient-reported outcome measures (PROMs) and improvement in the Hip disability and Osteoarthritis Outcome Score (HOOS) and the University of California at Los Angeles (UCLA) activity score. Inadequate improvement was defined as PROMs that changed by less than the minimal clinically important difference (MCID) for the HOOS pain and physical function short form (PS) and as failure to improve beyond a mostly homebound activity status for the UCLA activity score (a score of ≤3). The MCID and SCB thresholds were set at values reported in the literature. RESULTS One-year PROM data were available for 3,519 patients (74.6%). There were no differences in the proportion of patients who attained the MCID in terms of HOOS pain, HOOS PS, or UCLA activity scores at 1 year for all analyzed implant parameters. Multivariate regression demonstrated that implant selection was not a significant driver of inadequate improvement, according to HOOS pain and HOOS PS (p > 0.05). Larger (36-mm) femoral heads demonstrated lower odds of inadequate improvement versus 28-mm femoral heads according to UCLA activity scores (odds ratio [OR]: 0.64; 95% confidence interval, 0.47 to 0.86; p = 0.003). Implant-related criteria were not significant drivers of attaining a PASS or achieving an SCB with respect to HOOS pain. CONCLUSIONS For the most part, THA implant characteristics are not drivers of inadequate improvement with respect to pain and function. Surgeons should utilize implants with an acceptable track record that allow stable fixation and restoration of hip biomechanics. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Andrew Campbell
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Clement ND, Immelman RJ, MacDonald D, Breusch SJ, Howie CR. Survivorship and functional outcome of a cemented acetabular component with bulk roof autograft for severe acetabular dysplasia: 12- to 23-year follow-up. Hip Int 2021; 33:508-517. [PMID: 34802296 DOI: 10.1177/11207000211056905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIMS Primary aim was to determine survival of a cemented acetabular component with bulk roof autograft with a minimum of 12 years follow-up. The secondary aim was to determine the clinical outcome. METHODS A cohort of 62 consecutive patients (74 hips) undergoing cemented total hip arthroplasty with acetabular bulk roof autograft for acetabular dysplasia were retrospectively identified. The group consisted of 57 female patients (67 hips) and 5 male patients (7 hips) with a mean age at operation of 45 years. No patient was lost to follow-up, however 9 patients died had during the study period. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimensional Score (EQ-5D), Short Form (SF-12) physical score and patient satisfaction were used to assess clinical outcome for patients with a surviving prosthesis. RESULTS The median follow-up was 16.6 (13.4-19.1) years. 6 revisions were performed during the follow-up period, all of which were due to aseptic loosening of the acetabular component. The all-cause Kaplan Meier survival rate for the acetabular component was 99% at 10 years, 95% at 15 years and 83% at 20 years. Neither age, gender, femoral osteotomy or polyethylene (UHMW vs. cross-linked) were significant predictors of aseptic revision of the acetabular component. There were no case of graft resorption and all grafts were radiologically incorporated. 45 patients were available for functional assessment at a mean follow-up of 18.2 years. The mean OHS was 37.8, FJS was 55.7, EQ5D was 0.73, and SF-12 physical component was 43.2. No patient was dissatisfied, with 2 patients reporting a neutral satisfaction, 7 stating they were satisfied and the remaining 36 were very satisfied. CONCLUSIONS A cemented acetabular component with bulk roof autograft for dysplasia offers excellent survival with good to excellent functional outcome with high patient satisfaction in the medium- to long-term.
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Affiliation(s)
- Nick D Clement
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Deborah MacDonald
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Steffen J Breusch
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Colin R Howie
- Edinburgh Orthopaedics, The Royal Infirmary of Edinburgh, Edinburgh, UK
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Rykov K, Meys TWGM, Knobben BAS, Sietsma MS, Reininga IHF, Ten Have BLEF. MRI Assessment of Muscle Damage After the Posterolateral Versus Direct Anterior Approach for THA (Polada Trial). A Randomized Controlled Trial. J Arthroplasty 2021; 36:3248-3258.e1. [PMID: 34116911 DOI: 10.1016/j.arth.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is controversy in literature whether the direct anterior approach (DAA) results in less muscle damage compared with the posterolateral approach (PLA) for total hip arthroplasty. The aim of this randomized controlled trial was to assess muscle damage between these two approaches. METHODS Forty-six patients were included. Muscle atrophy, determined with the Goutallier classification, and muscle surface of twelve muscles were analyzed on magnetic resonance imaging images made preoperatively and one year postoperatively. Differences in component placement after DAA or PLA were assessed on radiographs. Harris hip scores and Hip disability and Osteoarthritis and Outcome Score were used as functional outcomes. RESULTS External rotator musculature was damaged in both approaches. After PLA, the obturator muscles showed significantly more atrophy and a decrease in muscle surface. After DAA, the tensor fascia latae showed an increased muscle atrophy and the psoas muscle showed a decreased muscle surface. An increase in muscle surface was seen for the rectus femoris, sartorius, and quadratus femoris after both approaches. The muscle surface of the gluteus medius and iliacus was also increased after PLA. No difference in muscle atrophy was found between the approaches for these muscles. The inclination angle of the cup in PLA was significantly higher. No differences were found in functional outcomes. CONCLUSION Different muscle groups were affected in the two approaches. After PLA, the external rotators were more affected, whereas the tensor fascia latae and psoas muscles were more affected after DAA.
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Affiliation(s)
- Kyrill Rykov
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Tim W G M Meys
- Department of Radiology, Martini Hospital Groningen, the Netherlands
| | - Bas A S Knobben
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Maurits S Sietsma
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Bas L E F Ten Have
- Department of Orthopaedic Surgery, Martini Hospital Groningen, the Netherlands
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The intraoperative use of a calliper predicts leg length and offset after total hip arthroplasty. Component subsidence influences the leg length. J Orthop Surg Res 2021; 16:424. [PMID: 34217347 PMCID: PMC8254249 DOI: 10.1186/s13018-021-02559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of total hip arthroplasty (THA) post-surgery and proper physiotherapy is positive recovery for the patient. Consideration is given to hip replacement biomechanics by ensuring no discrepancies in limb length (LL) and a stable prosthesis. Therefore, the patient must have proper preoperative planning and communication and a clear understanding of what to expect. Methods A prospective series of 59 THA operated by a single surgeon via Hardinge approach was studied, using an intraoperative calliper (CAL) to predict the change of LL and offset. We compared the results of the intraoperative changes before and after THA implantation with the reference of these values on anteroposterior x-ray pelvis. The importance of leg length balance and a good offset restoration is questioned, and the effect of component subsidence on leg length is considered. Results The average preoperative leg length discrepancy was −6.0 mm, postoperatively +3.6 mm. There was a strong correlation between the CAL measurements and the values on the x-ray (LL, r=0.873, p<0.01; offset, r=0.542, p<0.01). Reliability is better for limb length than for offset. These results are comparable within the literature and the statistical results from other studies reviewed. In addition, we evaluate the importance of subsidence of the prosthesis components for long-term results. Conclusion The intraoperative use of CAL gives excellent results in predicting the final LL and offset after THA. Considering subsidence of prosthesis components, a target zone around +5 mm might be more suitable for leg length directly postoperatively. Moreover, surgeons must discuss the topic of leg length discrepancy (LLD) intensively with the patient pre-operatively. Level of evidence Level 4, prospective cohort study
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Esbjörnsson AC, Kiernan S, Mattsson L, Flivik G. Geometrical restoration during total hip arthroplasty is related to change in gait pattern - a study based on computed tomography and three-dimensional gait analysis. BMC Musculoskelet Disord 2021; 22:369. [PMID: 33879123 PMCID: PMC8058981 DOI: 10.1186/s12891-021-04226-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background The effect of change in hip anatomy on change in gait pattern is not well described in current literature. Therefore, our primary aim was to describe and quantify changes in hip geometry and gait pattern 1 year after total hip arthroplasty (THA) in individuals with hip osteoarthritis. Our secondary aim was to explore the effect of postoperative change in femoral neck anteversion (FNA) and femoral offset and acetabular offset (FO/AO) quota on postoperative change in hip rotation and hip adduction moment during gait, respectively, 1 year after THA”. Methods Sixty-five individuals with primary hip osteoarthritis, scheduled for THA, were analyzed in this prospective intervention study. Participants were evaluated pre- and 1 year postoperatively with computed tomography-scans, three-dimensional gait analysis, and patient-reported outcome measures. Multiple linear regressions were performed to evaluate the association between change in joint anatomy and change in gait pattern after THA. Results One year postoperatively, global offset was symmetrical between sides as a result of decreased acetabular offset and increased femoral offset on the operated side. Quality of overall gait pattern improved, and participants walked faster and with less trunk lean over the affected side. FNA and hip rotations during walking changed equally in external and internal directions after THA and change in hip rotation during walking was associated with change in FNA in the same direction. An increase in external hip adduction moments was, on the other hand, not associated with change in FO/AO quota but with a more upright walking position and increased walking speed. Conclusions The findings of this study suggest that geometrical restoration during THA impacts postoperative gait pattern and, in addition to known factors such as FO, height of hip rotation center, and leg length discrepancy, the FNA must also be taken into consideration. Trial registration Trial registration: Clinicaltrial.gov, NCT01512550, Registered 19 January 2012 - Retrospectively registered.
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Affiliation(s)
- A-C Esbjörnsson
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden.
| | - S Kiernan
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
| | - L Mattsson
- Prophysics SOL, Jungmansvägen 3, 24335, Höör, Sweden
| | - G Flivik
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Skane University Hospital, 221 85, Lund, Sweden
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Clement ND, Gaston P, Bell A, Simpson P, Macpherson G, Hamilton DF, Patton JT. Robotic arm-assisted versus manual total hip arthroplasty. Bone Joint Res 2021; 10:22-30. [PMID: 33380216 PMCID: PMC7845457 DOI: 10.1302/2046-3758.101.bjr-2020-0161.r1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
AIMS The primary aim of this study was to compare the hip-specific functional outcome of robotic assisted total hip arthroplasty (rTHA) with manual total hip arthroplasty (mTHA) in patients with osteoarthritis (OA). Secondary aims were to compare general health improvement, patient satisfaction, and radiological component position and restoration of leg length between rTHA and mTHA. METHODS A total of 40 patients undergoing rTHA were propensity score matched to 80 patients undergoing mTHA for OA. Patients were matched for age, sex, and preoperative function. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and EuroQol five-dimension questionnaire (EQ-5D) were collected pre- and postoperatively (mean 10 months (SD 2.2) in rTHA group and 12 months (SD 0.3) in mTHA group). In addition, patient satisfaction was collected postoperatively. Component accuracy was assessed using Lewinnek and Callanan safe zones, and restoration of leg length were assessed radiologically. RESULTS There were no significant differences in the preoperative demographics (p ≥ 0.781) or function (p ≥ 0.383) between the groups. The postoperative OHS (difference 2.5, 95% confidence interval (CI) 0.1 to 4.8; p = 0.038) and FJS (difference 21.1, 95% CI 10.7 to 31.5; p < 0.001) were significantly greater in the rTHA group when compared with the mTHA group. However, only the FJS was clinically significantly greater. There was no difference in the postoperative EQ-5D (difference 0.017, 95% CI -0.042 to 0.077; p = 0.562) between the two groups. No patients were dissatisfied in the rTHA group whereas six were dissatisfied in the mTHA group, but this was not significant (p = 0.176). rTHA was associated with an overall greater rate of component positioning in a safe zone (p ≤ 0.003) and restoration of leg length (p < 0.001). CONCLUSION Patients undergoing rTHA had a greater hip-specific functional outcome when compared to mTHA, which may be related to improved component positioning and restoration of leg length. However, there was no difference in their postoperative generic health or rate of satisfaction. Cite this article: Bone Joint Res 2021;10(1):22-30.
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Affiliation(s)
- Nicholas D. Clement
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | | | - Philip Simpson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - Gavin Macpherson
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
| | - David F. Hamilton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
- Department of Orthopaedics, School of Clinical Sciences, Edinburgh, UK
- School of Health and Social Care, Edinburgh Napier University, Ediburgh, UK
| | - James T. Patton
- Department of Orthopaedics and Trauma, The Royal Infirmary of Edinburgh, Edinburgh, UK
- Spire Murrayfield Hospital, Edinburgh, UK
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An Extramedullary Spacing Block Technique to Restore Native Coronal Limb Alignment in TKA. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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33
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Foy M, Kielminski D, Cavazos D, Hussain A, Sood A, Gonzalez M. Changes in femoral offset is not associated with increased incidence of lateral hip pain following total hip arthroplasty. J Clin Orthop Trauma 2020; 16:132-135. [PMID: 33717947 PMCID: PMC7920158 DOI: 10.1016/j.jcot.2020.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/08/2020] [Accepted: 12/08/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Increased femoral offset following total hip arthroplasty allows for greater stability of the hip joint. However, the increase in femoral offset can cause an impingement of local structures resulting in persistent lateral hip pain. There is conflicting evidence whether changes in femoral offset increases the rates of lateral hip pain following total hip arthroplasty. METHODS This was a retrospective case control study that grouped patients based on the presence of persistent lateral hip pain following total hip arthroplasty. Patients were then stratified according to their change in femoral offset (<-5 mm, -5 mm < x < 5 mm, and 5 mm<). A chi squared analysis was then performed to see if there was a statistical difference in the rates of lateral hip pain amongst these groups. RESULTS A change in femoral offset of the implanted hip relative to the native hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p = 0.35). A change in femoral offset of the implanted hip relative to the contralateral hip was not associated with increased rates of lateral hip pain following total hip arthroplasty (p = 0.40). CONCLUSION This study found that there was no association between increased femoral offset and rates of postoperative lateral hip pain following total hip arthroplasty. Future investigations should look at a larger sample size with multiple institutions to further assess the impact on femoral offset changes on rates of persistent lateral hip pain.
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Affiliation(s)
- Michael Foy
- University of Illinois, College of Medicine, 112 CMW, 1853 West Polk Street, Chicago, IL, 60612, USA,Corresponding author.
| | - Daniel Kielminski
- University of Illinois, College of Medicine, 112 CMW, 1853 West Polk Street, Chicago, IL, 60612, USA
| | - Daniel Cavazos
- University of Illinois, College of Medicine, 112 CMW, 1853 West Polk Street, Chicago, IL, 60612, USA
| | - Awais Hussain
- Department of Orthopaedic Surgery, University of Illinois, E-270 MSS MC 844, 835 S. Wolcott Avenue, Chicago, IL, 60612-7342, USA
| | - Anshum Sood
- Department of Orthopaedic Surgery, University of Illinois, E-270 MSS MC 844, 835 S. Wolcott Avenue, Chicago, IL, 60612-7342, USA
| | - Mark Gonzalez
- Department of Orthopaedic Surgery, University of Illinois, E-270 MSS MC 844, 835 S. Wolcott Avenue, Chicago, IL, 60612-7342, USA
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Biggi S, Banci L, Tedino R, Capuzzo A, Cattaneo G, Tornago S, Camera A. Restoring global offset and lower limb length with a 3 offset option double-tapered stem. BMC Musculoskelet Disord 2020; 21:646. [PMID: 33008343 PMCID: PMC7532558 DOI: 10.1186/s12891-020-03674-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing. Methods From a consecutive series of 201 patients (201 hips) underwent primary cementless THA in our center with a minimum 3-year follow up, 80 patients (80 hips) were available for complete radiographic evaluation for GO and limb length (LL) and clinical evaluation with Harris hip score (HHS). All patients received the same femoral stem with three different offset options (option A with – 5 mm offset, option B and option C with + 5 mm offset, constant for each sizes) without changing stem length. Results Mean GO significantly increased by + 3 mm (P < 0.05) and mean LL significantly decreased by + 5 mm (P < 0.05) after surgery, meaning that postoperatively the limb length of the operated side increased by + 5 mm. HHS significantly improved from 56.3 points preoperatively to 95.8 postoperatively (P < 0.001). Offset option A was used in 1 hip (1%), B in 59 hips (74%) and C in 20 hips (25%). Conclusions The femur is lateralized with a mean of + 5 mm after surgery than, the native anatomy, whatever type of stem was used. Thus, the use of this 3-offset options femoral stem is effective in restoring the native biomechanical hip parameters as GO, even if 2 offset options were considered sufficient to restore GO.
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Affiliation(s)
- Stefano Biggi
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy. .,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy.
| | | | - Riccardo Tedino
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | - Andrea Capuzzo
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | - Gabriele Cattaneo
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
| | | | - Andrea Camera
- Clinica Città di Alessandria - Policlinico di Monza, via Moccagatta 30, 15122, Alessandria, AL, Italy.,Fondazione Lorenzo Spotorno - Onlus, Albenga, SV, Italy
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Influencing Factors for Joint Perception After Total Hip Arthroplasty: Asian Cohort Study. J Arthroplasty 2020; 35:1307-1314. [PMID: 31980209 DOI: 10.1016/j.arth.2019.12.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 12/14/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Perceiving replaced joints as natural is one of the best scenario after total hip arthroplasty (THA). We investigated the distribution of and influencing factors for patient's joint perception after THA in Asian cohort, which is not well known. METHODS We mailed a questionnaire to Asian patients who had undergone THA in our institution between 2012 and 2016, and this study included 318 Asian patients. The questionnaire assessed patient's joint perception, Oxford Hip Score (OHS), Short Form-12 Health Survey (SF-12) physical, mental, and role component summaries, and satisfaction score. Leg length discrepancy and global femoral offset before and after THA were measured using radiographs. The patients were divided into 2 groups with patient's joint perception: natural and artificial perception groups. OHS, SF-12, satisfaction, leg length discrepancy, and global femoral offset were compared between natural and artificial perception groups, and which factors significantly influenced joint perception were determined. RESULTS Of the 318 patients, 165 patients (51.8%) perceived their replaced joint as a natural joint. OHS, SF-12 physical and role component summaries, and satisfaction score in natural perception group were significantly higher than those in artificial perception group, without significant difference in SF-12 mental component summary. Multivariate analysis showed that less of usual pain, easier to get in or out of a car, and osteoarthritis in the contralateral hip were positively associated with natural joint perception after THA. CONCLUSION This study indicated to surgeons that pain relief and improvement in getting in or out of a car after THA could lead to even better patient's joint perception.
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Comparison of component positioning in robot-assisted and conventional total hip arthroplasty. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.656702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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The effect of postoperative femoral offset on outcomes after hip arthroplasty: A systematic review. J Orthop 2020; 22:5-11. [PMID: 32273666 DOI: 10.1016/j.jor.2020.03.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
The purpose of this systematic review was to analyze the effect of decreased, restored, or increased femoral offset on patient reported outcomes (PROs) following hip arthroplasty. Databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. With regard to Harris Hip Score, two studies reported superior outcomes for the increased femoral offset group, one study reported superior outcomes for a restored offset group, and the final study reported favorable outcomes for the decreased offset group. Patients with restored offset following arthroplasty may demonstrate superior PROs.
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Debbi EM, Rajaee SS, Mayeda BF, Penenberg BL. Determining and Achieving Target Limb Length and Offset in Total Hip Arthroplasty Using Intraoperative Digital Radiography. J Arthroplasty 2020; 35:779-785. [PMID: 31699530 DOI: 10.1016/j.arth.2019.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Achieving appropriate limb length and offset in total hip arthroplasty (THA) is challenging. Target limb length and offset may not always mean equal radiographic measurements bilaterally. The goal of this study is to introduce a method for determining as well as achieving target limb length and offset using digital radiographic measurements. METHODS One hundred and two consecutive patients with unilateral hip osteoarthritis undergoing primary THA in the lateral decubitus position were included. Limb length and offset were measured on anterior-posterior pelvic radiographs preoperatively, intraoperatively, and postoperatively. Offset was defined as the length of a line parallel to the inter-teardrop line, extending from the edge of the ischium, at about the lower border of the ipsilateral obturator foramen, to the edge of the femoral cortex, usually at, or just below, the neck resection level. Target limb length was determined for each patient based on patient perception and severity of disease. Target offset equaled the contralateral limb. Using intraoperative digital radiography, adjustments were made until targets were achieved and the hip was stable. Patients were followed for an average of 4.2 years postoperatively. RESULTS Limb length was within 5 mm of target measurements in 100% of patients and offset was within 5 mm of targets in 97.1%. Target measurements differed by >5 mm from the contralateral side in 2.0% of limb length and 2.9% of offset measurements. There were no significant differences between intraoperative and postoperative limb length (P = .261) or offset (P = .747) measurements. At final follow-up, there were no dislocations or reoperations and average Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 95.78. CONCLUSION Target limb length and offset goals can be determined for most patients undergoing THA. Targets are not always equal to the contralateral side. Intraoperative digital radiography can allow surgeons to accurately achieve target limb length and offset to within 5 mm in a homogenous cohort of patients with unilateral hip osteoarthritis with excellent clinical outcomes.
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Affiliation(s)
- Eytan M Debbi
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Sean S Rajaee
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brian F Mayeda
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Brad L Penenberg
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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FEATURES OF THE ABDUCTION MECHANISM WORK BEFORE AND AFTER TOTAL HIP JOINT ARTHROPLASTY. WORLD OF MEDICINE AND BIOLOGY 2020. [DOI: 10.26724/2079-8334-2020-3-73-134-139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Valente G, Lanting B, MacDonald S, Teeter MG, Van Citters D, Howard J. Femoral head material loss at the head-neck junction in total hip arthroplasty: the effect of head size, stem material and stem offset. Hip Int 2019; 29:647-651. [PMID: 30499342 DOI: 10.1177/1120700018814473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Material loss at the head-neck junction in total hip arthroplasty may cause adverse clinical symptoms and implant failure. The purpose of this study was to quantitatively examine the effects of head size, stem material and stem offset on material loss of the head-neck taper interface of a single trunnion design in retrieval implants of metal on polyethylene bearing surfaces. METHODS A retrieval study was performed to identify all 28-mm and 32-mm femoral heads from a single implant/taper design implanted for >2 years. This included n = 56 of the 28-mm heads and n = 23 of the 32-mm heads. The 28-mm femoral heads were matched to 32-mm femoral heads based on time in vivo and head length. A coordinate measuring machine was used to determine maximum linear corrosion depth (MLD). Differences in MLD for head diameter, stem material, and stem offset were determined. RESULTS There were no differences between groups for age, gender, BMI, or implantation time. There was no difference in MLD between 28 mm and 32 mm matched paired head diameters (p = 0.59). There was also no difference in MLD between titanium or cobalt-chromium stems (p = 0.79), and regular or high-offset stems (p = 0.95). CONCLUSION There is no statistical difference in femoral head MLD at the head-neck junction in THA between 28-mm and 32-mm matched paired femoral heads, similar or mixed alloy coupled femoral head stem constructs, and regular or high offset stems.
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Affiliation(s)
- Giuseppe Valente
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Brent Lanting
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Steven MacDonald
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
| | - Matthew G Teeter
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Surgical Innovation Program, Lawson Health Research Institute, London, ON, Canada
| | | | - James Howard
- Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London Health Sciences Centre, University Hospital, London, ON, Canada
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Austin DC, Dempsey BE, Kunkel ST, Torchia MT, Jevsevar DS. A comparison of radiographic leg-length and offset discrepancies between 2 intraoperative measurement techniques in anterior total hip arthroplasty. Arthroplast Today 2019; 5:181-186. [PMID: 31286041 PMCID: PMC6588659 DOI: 10.1016/j.artd.2018.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/09/2018] [Accepted: 09/11/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anterior total hip arthroplasty (THA) allows the use of intraoperative fluoroscopy to assess leg-length and offset discrepancies. Two techniques to accomplish this are the transverse rod method and the radiographic overlay method. The aim of this study was to determine if they are equally effective options for minimizing postoperative radiologic discrepancies. METHODS We completed a retrospective cohort study comparing 106 anterior THAs from 1 surgeon using the transverse rod technique to 94 anterior THAs from another surgeon using the radiograph overlay technique. Radiographic leg-length discrepancy (LLD) and offset discrepancy (OD) were measured independently on postoperative radiographs. Parametric, nonparametric, and categorical statistical tests were used to compare LLD and OD between groups. RESULTS Baseline characteristics were similar between groups. The mean LLD of 4.8 mm in the radiograph overlay group was not significantly different from the 4.4 mm mean discrepancy in the transverse rod group (P = .424), and the rates of LLD < 5 mm and LLD < 10 mm were not significantly different (P = .772, P = .179). The mean OD of 5.1 mm in the radiograph overlay group was not significantly different from the 4.8 mm mean discrepancy in the transverse rod group (P = .668), and there was no significant difference in the rates of OD < 5 mm and OD < 10 mm (P = .488, P = .878). CONCLUSIONS There was no difference between the measured LLD and OD by the 2 surgeons, suggesting that the techniques are equally effective options.
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Affiliation(s)
- Daniel C Austin
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Brendan E Dempsey
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
| | - Samuel T Kunkel
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Michael T Torchia
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
- Department of Orthopaedics, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA
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Soodmand E, Zheng G, Steens W, Bader R, Nolte L, Kluess D. Surgically Relevant Morphological Parameters of Proximal Human Femur: A Statistical Analysis Based on 3D Reconstruction of CT Data. Orthop Surg 2019; 11:135-142. [PMID: 30809957 PMCID: PMC6430457 DOI: 10.1111/os.12416] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/07/2018] [Accepted: 12/13/2018] [Indexed: 01/14/2023] Open
Abstract
Objectives Recently, more accurate description of the femoral geometry has become of interest to engineers and orthopedic surgeons. However, an appropriate database is lacking. Therefore, the aim of this study is to present morphological parameters and their correlations, which are relevant for medical issues such as impingement after total hip replacement, as well as for implant design and the etiology of hip fractures. Methods We investigated 12 well‐known morphological parameters of the femur in 169 healthy human subjects through evaluation of 3D‐reconstructed CT scans. Pearson's coefficients of correlations were calculated using a statistical t‐test method for each pair of parameters. Results The mean, maximum, minimum, median, and standard deviation values are reported for all parameters. Histograms showing the distribution of each morphological parameter are also presented. It is shown that absolute and horizontal offsets, total femur length, and NCVD parameters are normally distributed, but NCDF and NCDS are not. Furthermore, an inter‐correlation matrix was reported to reveal statistical correlations between these parameters. The strongest positive correlation existed between absolute offset (OSA) and horizontal offset (OSH), while the least positive correlation was found between NCDF and total femur length (TFL), and also between NCDS and NCDF. Anteversion angle (ATA) and OSA showed the least negative correlation. However, the strongest negative correlation was found between neck‐shaft angle (NSA) and greater trochanter height (GTH), as well as between OSA and NCVD. Conclusions Comprehending patients’ native bone morphology, including the variations and correlations, is essential for orthopedic surgeons to undertake preoperative planning and surgery as well as to appropriately design medical devices. Thus, more population‐based detailed databases are necessary. We investigated an extensive set of proximal femoral morphology parameters using a statistically standardized method to expand the existing knowledge. The results of our study can be used for diverse medical and biomechanical purposes.
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Affiliation(s)
- Ehsan Soodmand
- Department of Orthopaedics, University Medicine of Rostock, Rostock, Germany
| | - Guoyan Zheng
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Wolfram Steens
- Department of Orthopaedics, University Medicine of Rostock, Rostock, Germany
| | - Rainer Bader
- Department of Orthopaedics, University Medicine of Rostock, Rostock, Germany
| | - Lutz Nolte
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Daniel Kluess
- Department of Orthopaedics, University Medicine of Rostock, Rostock, Germany
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Yi LH, Li R, Zhu ZY, Bai CW, Tang JL, Zhao FC, Zheng X, Guo KJ. Anatomical study based on 3D-CT image reconstruction of the hip rotation center and femoral offset in a Chinese population: preoperative implications in total hip arthroplasty. Surg Radiol Anat 2018; 41:117-124. [PMID: 30488299 DOI: 10.1007/s00276-018-2143-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Several anatomical studies regarding the value of hip rotation center (HRC) and femoral offset (FO) have been performed in Western populations. However, there are a few data on hip morphological values in the Chinese population based on CT scans. This study measured the values of the hip and pelvis, especially HRC and FO, in a Chinese population and compared them with the published values obtained from Western populations. PATIENTS AND METHODS One hundred patients (50 females and 50 males) were included in the present study, and 3D-CT reconstructions of the hip and pelvis were generated. The mean age was 51.4 ± 8.9 years and mean body mass index (BMI) was 23.5 ± 2.6 kg/m2. All the morphologic measurements were compared between genders and sides, and the relationships between different parameters were analyzed. RESULTS The mean FO values were 38.4 ± 4.7 mm and 35.6 ± 4.4 mm for the males and females, respectively. A significant negative correlation was noted between FO and neck shaft angle (NSA) in both genders (r = - 0.262, P = 0.009 for the males, r = - 0.350, P ≤ 0.001 for the females). A significant positive correlation was found between horizontal distance (HD) and diameter of the femoral head (DFH) in both genders (r = 0.734, P ≤ 0.001 for the males, r = 0.658, P ≤ 0.001 for the females). A significant positive correlation was noted between HD and pelvic width (PW) in males (r = 0.455, P ≤ 0.001). A significant positive correlation was also noted between HD and pelvic height (PH) in males (r = 0.318, P ≤ 0.001). A significant positive correlation was observed between FO and pelvic cavity height (PCH) in males (r = 0.411, P ≤ 0.001), and a significant positive correlation was observed between VD and PCH in females (r = 0.497, P ≤ 0.001). The tip of the greater trochanter was, on average, 7.0 mm higher than the femoral head center. Relationships between DFH and pelvic morphometric parameters were also observed. CONCLUSION The present morphological data and the relationships between them can be applied to design better ethnic-specific THA prostheses and preoperative plans.
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Affiliation(s)
- Lin-Hong Yi
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Rui Li
- Department of Medical Imaging, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zheng-Ya Zhu
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chao-Wen Bai
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jin-Long Tang
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Feng-Chao Zhao
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xin Zheng
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
| | - Kai-Jin Guo
- Department of Orthopaedics, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
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Brunner JH, Foucher KC. Sex specific associations between biomechanical recovery and clinical recovery after total hip arthroplasty. Clin Biomech (Bristol, Avon) 2018; 59:167-173. [PMID: 30266024 DOI: 10.1016/j.clinbiomech.2018.09.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/10/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are sex-specific gait differences in men and women before and after total hip arthroplasty (THA) but we do not know their impact on clinical outcomes. The objective of this study was to identify sex-specific associations between pre- and postoperative changes in pain and function and (i) gait mechanics, (ii) passive range of motion, and (iii) abductor strength. METHODS Pre- and one-year postoperative data were identified from a data repository (n = 124; 64 Women; Age 61 (SD 10); BMI 29 (SD 5)). We used linear regression analysis to identify sex-specific associations between Harris Hip Score pain and function subscores, and sagittal plane hip kinematics and 3D hip kinetics during gait, hip abductor strength, and passive hip range of motion (RoM). FINDINGS Combinations of biomechanical variables predicted up to 24% of the variation in pain improvement and up to 27% of the variation in functional improvement. In men, increased peak external rotation moments were associated with pain improvement. Passive flexion RoM and peak extension moments were associated with functional improvement. In women, increased passive adduction RoM and peak external rotation moments were associated with pain improvement. Peak adduction moments and passive flexion RoM were associated with functional improvement. INTERPRETATIONS The different associations between improvement in clinical outcomes and improvement in gait, passive RoM, and abductor strength suggest that the biomechanical path to recovery may be different in men and women.
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Affiliation(s)
- J Heather Brunner
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, IL, USA
| | - Kharma C Foucher
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA; Department of Bioengineering, University of Illinois at Chicago, Chicago, IL, USA.
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Al-Dirini RMA, Martelli S, Huff D, Zhang J, Clement JG, Besier T, Taylor M. Evaluating the primary stability of standard vs lateralised cementless femoral stems - A finite element study using a diverse patient cohort. Clin Biomech (Bristol, Avon) 2018; 59:101-109. [PMID: 30219523 DOI: 10.1016/j.clinbiomech.2018.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/03/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restoring the original femoral offset is desirable for total hip replacements as it preserves the original muscle lever arm and soft tissue tensions. This can be achieved through lateralised stems, however, the effect of variation in the hip centre offset on the primary stability remains unclear. METHODS Finite element analysis was used to compare the primary stability of lateralised and standard designs for a cementless femoral stem (Corail®) across a representative cohort of male and female femora (N = 31 femora; age from 50 to 80 years old). Each femur model was implanted with three designs of the Corail® stem, each designed to achieve a different degree of lateralisation. An automated algorithm was used to select the size and position that achieve maximum metaphyseal fit for each of the designs. Joint contact and muscle forces simulating the peak forces during level gait and stair climbing were scaled to the body mass of each subject. FINDINGS The study found that differences in restoring the native femoral offset introduce marginal differences in micromotion (differences in peak micromotion <21 μm), for most cases. Nonetheless, significant reduction in the interfacial strains (>3000 με) was achieved for some subjects when lateralized stems were used. INTERPRETATION Findings of this study suggest that, with the appropriate size and alignment, the standard offset design is likely to be sufficient for primary stability, in most cases. Nonetheless, appropriate use of lateralised stems has the potential reduce the risk of peri-prosthetic bone damage. This highlights the importance of appropriate implant selection during the surgical planning stage.
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Affiliation(s)
- Rami M A Al-Dirini
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide 5043, Australia.
| | - Saulo Martelli
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide 5043, Australia
| | - Daniel Huff
- DePuy Synthes, Johnson and Johnson, Warsaw, USA
| | - Ju Zhang
- Auckland Bioengineering Institute, The University Auckland, Auckland, New Zealand
| | - John G Clement
- Melbourne Dental School, The University of Melbourne, Melbourne, Australia
| | - Thor Besier
- Auckland Bioengineering Institute, The University Auckland, Auckland, New Zealand
| | - Mark Taylor
- Medical Device Research Institute, College of Science and Engineering, Flinders University, Adelaide 5043, Australia.
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Klasan A, Sen A, Dworschak P, El-Zayat BF, Ruchholtz S, Schuettler KF, Schmitt J, Heyse TJ. Ten-year follow-up of a cemented tapered stem. Arch Orthop Trauma Surg 2018; 138:1317-1322. [PMID: 30043147 DOI: 10.1007/s00402-018-3002-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION This stem was cleared by the FDA in 2002 and has been implanted in cementless and cemented versions. Despite its long history, there are no long-term clinical results available for the cemented version of this implant. The aim of this study was to provide such data. It was hypothesized that this implant delivers clinical success comparable to other tapered cemented stems. MATERIALS AND METHODS A total of 113 hip replacements were performed in 106 patients between October 2007 and December 2009 using the cemented version of this stem. The mean age of the patients at operation was 74.8 years (range 50-91 years). The mean follow-up was 8.9 years with only two patients lost to follow-up. Implant survival was determined using the Kaplan-Meier analysis. RESULTS Stem survival with revision for any reason as the endpoint was 96.4% after 10 years. Survival for stem aseptic loosening was 100%. There were no cases of osteolysis. Clinical outcomes, as shown by Harris Hip Scores, were in line with previous investigations and the rate of adverse events was very low. CONCLUSIONS This is a modern cemented stem with an excellent survival rate and satisfactory functional outcomes. In this cohort, there were no failures related to the stem through the first decade.
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Affiliation(s)
- Antonio Klasan
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany.
| | - Ahmet Sen
- Department for Trauma, Clinic Jung-Stilling, Wichernstraße 40, 57074, Siegen, Germany
| | - Philipp Dworschak
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Bilal Farouk El-Zayat
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Steffen Ruchholtz
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Karl F Schuettler
- Center for Orthopedics and Traumatology, University Hospital Marburg, Baldingerstrasse, 35043, Marburg, Germany
| | - Jan Schmitt
- Department for Orthopedics, Clinic Wetzlar, Forsthausstraße 1, 35578, Wetzlar, Germany
| | - Thomas J Heyse
- ORTHOmedic Frankfurt Offenbach, Herrnstr. 57, 63065, Offenbach, Germany
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Brumat P, Pompe B, Antolič V, Mavčič B. The impact of canal flare index on leg length discrepancy after total hip arthroplasty. Arch Orthop Trauma Surg 2018; 138:123-129. [PMID: 29134317 DOI: 10.1007/s00402-017-2840-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The femoral stem should protrude from femur by an appropriate vertical distance to allow leg length equalization at hip arthroplasty; this distance depends on the size/shape of medullary canal and implant. The relationship between femoral morphology and achievability of leg length restoration is currently unclear. Our aim was to examine the impact of the femoral canal flare index (CFI) on the risk of leg length discrepancy (LLD) after total hip arthroplasty with different femoral stems. MATERIALS AND METHODS The study cohort included 126 patients with unilateral primary total hip arthroplasty due to idiopathic osteoarthritis and three different types of implanted femoral stems. The impact of CFI on postoperative LLD was assessed with separate logistic regression model for each implant and covariables of age, gender, body mass index and femoral neck resection level. RESULTS Higher CFI was an independent risk factor for postoperative LLD ≥ 5 mm with odds ratio 4.5 (p = 0.03) in 49 stems with cementless metaphyseal fixation Implantcast-EcoFit®, regardless of the femoral neck resection level. CFI had no significant impact on LLD in 30 stems with cementless diaphyseal fixation EndoPlus-Zweymüller® or 47 cemented collared stems Link-SPII®. No significant difference was observed between groups in pre/postoperative WOMAC scores, postoperative radiographic LLD, subjectively reported LLD, insole use or complications after mean 6.8 years of follow-up. CONCLUSIONS Higher CFI increases the risk of clinically detectable postoperative LLD in single-wedge femoral stems with cementless metaphyseal fixation. CFI has no significant impact on LLD in femoral stems with cementless diaphyseal fixation or cemented fixation.
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Affiliation(s)
- Peter Brumat
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Borut Pompe
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Vane Antolič
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia
| | - Blaž Mavčič
- University Medical Centre Ljubljana and Faculty of Medicine, Zaloška 9, 1000, Ljubljana, Slovenia.
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Rüdiger HA, Guillemin M, Latypova A, Terrier A. Effect of changes of femoral offset on abductor and joint reaction forces in total hip arthroplasty. Arch Orthop Trauma Surg 2017; 137:1579-1585. [PMID: 28905107 DOI: 10.1007/s00402-017-2788-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Indexed: 02/09/2023]
Abstract
BACKGROUND Anatomical reconstruction in total hip arthroplasty (THA) allows for physiological muscle function, good functional outcome and implant longevity. Quantitative data on the effect of a loss or gain of femoral offset (FO) are scarce. The aim of this study was to quantitatively describe the effect of FO changes on abductor moment arms, muscle and joint reactions forces. METHODS THA was virtually performed on 3D models built from preoperative CT scans of 15 patients undergoing THA. Virtual THA was performed with a perfectly anatomical reconstruction, a loss of 20% of FO (-FO), and a gain of 20% of FO (+FO). These models were combined with a generic musculoskeletal model (OpenSim) to predict moment arms, muscle and joint reaction forces during normal gait cycles. RESULTS In average, with -FO reconstructions, muscle moment arms decreased, while muscle and hip forces increased significantly (p < 0.001). We observed the opposite with +FO reconstructions. Gluteus medius was more affected than gluteus minimus. -FO had more effect than +FO. A change of 20% of FO induced an average change 8% of abductor moment arms, 16% of their forces, and 6% of the joint reaction force. CONCLUSIONS To our knowledge, this is the first report providing quantitative data on the effect of FO changes on muscle and joint forces during normal gait. A decrease of FO necessitates an increase of abductor muscle force to maintain normal gait, which in turn increases the joint reaction force. This effect underscores the importance of an accurate reconstruction of the femoral offset.
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Affiliation(s)
- Hannes A Rüdiger
- Department of Orthopaedics and Traumatology, Centre Hospitalier Universitaire Vaudois CHUV, Av. Pierre Decker 4, Lausanne, 1011, Switzerland. .,Department of Orthopaedic Surgery, Schulthess Clinic, Lengghalde 2, Zurich, 8008, Switzerland.
| | - Maïka Guillemin
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 15, Lausanne, 1015, Switzerland
| | - Adeliya Latypova
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 15, Lausanne, 1015, Switzerland
| | - Alexandre Terrier
- Laboratory of Biomechanical Orthopedics, Ecole Polytechnique Fédérale de Lausanne, Station 15, Lausanne, 1015, Switzerland
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Lakstein D, Atoun E, Wissotzky O, Tan Z. Does restoration of leg length and femoral offset play a role in functional outcome one year after hip hemiarthroplasty? Injury 2017; 48:1589-1593. [PMID: 28477993 DOI: 10.1016/j.injury.2017.04.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 04/11/2017] [Accepted: 04/25/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The objective of this study was to evaluate the correlation between specific joint biomechanical parameters and 1year functional outcome scores in elderly patients receiving hemiarthroplasty in the setting of intracapsular hip fractures. METHODS This is a retrospective, institutional registry based study. 168 hip hemarthroplasties were captured from October 2013 to June 2015. Patients were excluded based on contralateral hip surgery, perioperative complications or inadequate radiographs. 84 patients were alive at one year follow up. We compared mobility and pain scores to radiographically determined variations of leg lengths and femoral offset. We also compared the performance of fellowship trained arthroplasty surgeons to their non-fellowship trained counterparts. RESULTS The operated leg was a mean of 1.12±6.8mm longer than the contralateral. leg length discrepancy (LLD) was less than 10mm in 72 patients. Mean difference in offset between limbs was 0.25±3.3mm. The difference was within 5mm in 79 patients (94%). We found no statistically significant correlation between mobility or pain scores and variations in leg length or offset. We found significantly better performance of the arthroplasty surgeons in restoring leg length but no difference in offset reconstruction or functional benefit for the patient. CONCLUSIONS Our study was unable to demonstrate a significant relationship between leg length or femoral offset restoration and the patient's ultimate functional recovery. Arthroplasty surgeons performed better in restoring leg length, but no associated functional advantage was seen.
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Affiliation(s)
- Dror Lakstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Orthopedic Department, E. Wolfson Medical Center, Holon, POB 58100, Israel.
| | - Ehud Atoun
- Orthopedic Department, Barzilai Medical Center, Ashkelon, Israel; Faculty of Medicine, Ben-gurion University, Beer-Sheva, Israel
| | - Orit Wissotzky
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Zachary Tan
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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