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Castagnini F, Bordini B, Cosentino M, Tassinari E, Guizzardi G, Traina F. Comparison of single taper and dual taper versions of the same stem design in total hip arthroplasty for primary osteoarthritis. J Orthop Traumatol 2023; 24:5. [PMID: 36725766 PMCID: PMC9892395 DOI: 10.1186/s10195-023-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In total hip arthroplasty (THA), the outcomes of single taper (ST) and dual taper (DT) versions of the same stem design have been scarcely studied. A registry study comparing ST and DT versions of the same stem design was designed, aiming to assess: (1) the survival rates and the hazard ratios for failure; (2) the survival rates and the hazard ratios for failure using stem-focused endpoints. MATERIAL AND METHODS A regional arthroplasty registry was interrogated about stem designs with ST and DT versions in cementless THAs performed for primary osteoarthritis. Only the same cup and ceramic-on-ceramic bearings were included: the DT stems had a titanium-on-titanium modularity. Demographic and implant features were recorded. Survival rates and hazard ratios were evaluated and compared. Stem-focused endpoints were also investigated. RESULTS A total of 5359 THAs were included, with three stem designs. The two versions of every stem showed different demographics and implant-related features: ST versions were preferentially implanted in heavier young men. For each stem, the two versions had similar survival rates at 5 years (p = 0.076; p = 0.319; p = 0.616) and similar adjusted hazard ratios for failures (p = 0.084; p = 0.308; p = 0.729). When stem-focused endpoints were adopted, the ST and DT versions of the three stems achieved similar survival rates (p = 0.710; p = 0.784; p = 0.983) and similar adjusted hazard ratios (p = 0.647; p = 0.858; p = 0.787). Three neck breakages occurred (0.0007% of all the modular implants). CONCLUSIONS ST and DT versions of the same stem design did not show any differences in terms of survival rates and hazard ratios for failures at 5 years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Francesco Castagnini
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Barbara Bordini
- grid.419038.70000 0001 2154 6641Laboratorio Di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136 Bologna, Italy
| | - Monica Cosentino
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Enrico Tassinari
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Giulia Guizzardi
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Francesco Traina
- grid.419038.70000 0001 2154 6641Ortopedia-Traumatologia e Chirurgia Protesica e Dei Reimpianti d’anca E Di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy ,grid.6292.f0000 0004 1757 1758DIBINEM, Università Di Bologna, Bologna, Italy
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Huang Z, Zhang Z, Lu X, Liu Y, Zhang H. The influence of prosthetic positioning and proximal femoral morphology on leg length discrepancy and early clinical outcomes of cementless total hip arthroplasty. J Orthop Surg Res 2023; 18:408. [PMID: 37277763 DOI: 10.1186/s13018-023-03847-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Leg length discrepancy (LLD) is a common complication of total hip arthroplasty (THA). However, the relationship between femoral prosthesis filling, proximal femoral morphology, and acetabular prosthesis positioning with postoperative LLD and clinical outcomes is unclear. The aims of this study were to investigate the influence of canal flare index (CFI), canal fill ratio (CFR), center of rotation (COR), and femoral offset (FO) on (1) postoperative LLD; and (2) clinical outcomes in the two stem designs with different coating distribution. METHODS The study cohort included 161 patients who underwent primary cementless THA between January 2021 and March 2022 with either proximal coating or full coating stems. Multivariate logistic regression was used to assess the effect of CFI, CFR, COR, and FO on postoperative LLD, and linear regression to assess their effect on clinical outcomes. RESULTS No statistical difference was found in clinical outcomes or postoperative LLD between the two groups. High CFI (p = 0.014), low ΔVCOR (p = 0.012), and Gender (p = 0.028) were found independent risk factors for LLD one day postoperative. High CFI was also an independent risk factor for postoperative subjectively perceived LLD (p = 0.013). CFR at the level of 2 cm below the LT (p = 0.017) was an independent risk factor for Harris Hip Score. CONCLUSIONS Proximal femoral morphology and acetabular prosthesis positioning but not femoral prosthesis filling affected the LLD. High CFI was an independent risk factor for postoperative LLD and subjectively perceived LLD, and low ΔVCOR was also an independent risk factor for postoperative LLD. Women were susceptible to postoperative LLD.
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Affiliation(s)
- Zhenchao Huang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Zian Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Xinzhe Lu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Yikai Liu
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China
| | - Haining Zhang
- Department of Joint Surgery, The Affiliated Hospital of Qingdao University, Qingdao, 266000, Shandong, China.
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Castagnini F, Bordini B, Cosentino M, Di Liddo M, Tella G, Masetti C, Traina F. Age and Sex Influence the Use of Modular Femoral Components in Total Hip Arthroplasty Performed for Primary Osteoarthritis. J Clin Med 2023; 12:jcm12030984. [PMID: 36769632 PMCID: PMC9918162 DOI: 10.3390/jcm12030984] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
The impact of age and sex on femoral component choices in modular total hip arthroplasty (THA) is still unknown. A regional arthroplasty registry was interrogated about a modular stem in THA performed for primary osteoarthritis, with the aims to assess the influence of age and sex on stems sizes and neck choices. A total of 6830 THAs were included: all THAs had a modular stem (with 15 necks and 27 combinations per side). Patients were stratified by age in decades and sex. Necks were grouped according to the type of correction. The percentage of larger stem sizes increased in males and in elder patients (p < 0.001). Standard necks were overrepresented in males aged 40-59 and underrepresented in males aged 70 or older (p < 0.001). Half of the necks provided other corrections than standard or offset, especially in males aged 40-49 and females aged 70 or older (p < 0.001). Offset necks were predominant in elder patients (p < 0.001). Version-correcting necks were prevalent in younger males and older females (p < 0.001). Varus necks were implanted in one-third of the cases. The four commonest necks showed age and sex specific patterns. In the registry, age and sex impacted stem size and neck choices in THA performed for primary osteoarthritis.
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Affiliation(s)
- Francesco Castagnini
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Correspondence:
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Monica Cosentino
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Michele Di Liddo
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Giuseppe Tella
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Claudio Masetti
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Francesco Traina
- Ortopedia-Traumatologia e Chirurgia Protesica e dei Reimpianti d’Anca e di Ginocchio, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, 40126 Bologna, Italy
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Hasegawa K, Hatsushikano S, Watanabe K, Ohashi M, Dubousset J. Scoliosis Research Society-22r score is affected by standing whole body sagittal alignment, age, and sex, but not by standing balance or skeletal muscle mass in healthy volunteers. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3000-3012. [PMID: 36053322 DOI: 10.1007/s00586-022-07360-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 08/01/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Aging and spinal disease impair standing whole body sagittal alignment (WBS alignment), which leads to stooping. When WBS alignment deteriorates, compensatory mechanisms are activated to maintain standing posture. Increase of the compensation impairs health-related quality of life (HRQOL). The purpose of this research was to determine whether postural factors, age, and sex affect HRQOL. METHODS This cross-sectional study evaluated the influence of WBS alignment, standing body sway (balance), skeletal muscle mass (SMM), aging, and sex on HRQOL in healthy volunteers (n = 150; mean age 40.9 years [20-76], 96 women). Age, sex, weight, height, and body mass index (BMI) were obtained. HRQOL was assessed with Scoliosis Research Society-22 (SRS-22r). WBS alignment and balance were measured by EOS imaging with simultaneous force plate measurement. SMM was measured using a medical body composition analyzer. Based on the bivariate analysis between the SRS-22r subtotal and all parameters, selected ten parameters were used for multivariate logistic regression analysis to identify affecting factors to SRS-22r. RESULTS Men had significantly higher weight, height, BMI, and SRS-22r score in all domains. The L4-S1 lumbar lordosis angle was greater in men, and pelvic tilt and knee hyperextension were greater in women. Women had a more stable standing posture, whereas men had significantly higher SMM values. Multivariate logistic regression analysis revealed that age, sex, and TPA were identified as significant factors affecting SRS-22r. CONCLUSIONS In healthy volunteers, SRS-22r is affected by aging, sex (woman had a lower score), and sagittal malalignment. Neither Standing balance nor SMM, however, affect SRS-22r.4.
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Affiliation(s)
- Kazuhiro Hasegawa
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan.
| | - Shun Hatsushikano
- Niigata Spine Surgery Center, 2-5-22 Nishi-machi, Niigata City, 950-0165, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masayuki Ohashi
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Jean Dubousset
- Académie Nationale de Médecine, 16 Rue Bonaparte, 75006, Paris, France
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Hu Y, Ying H, Yu D, Mao Y, Yan M, Li H, Zeng Y, Zhai Z. Positive Correlation Between the Femur Neck Shaft and Anteversion Angles: A Retrospective Computed Tomography Analysis in Patients With Developmental Dysplasia of the Hip. J Arthroplasty 2022; 37:538-543. [PMID: 34923094 DOI: 10.1016/j.arth.2021.12.013] [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: 10/04/2021] [Revised: 11/22/2021] [Accepted: 12/10/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to explore the anatomical correlation between the femoral neck shaft angle (NSA) and femoral anteversion angle (AA) in patients with developmental dysplasia of the hip based on the Crowe classification and provide a novel method to estimate the femoral AA on anteroposterior pelvic radiographs. METHODS A total of 208 patients with dysplastic hips who underwent total hip arthroplasty at our institution were retrospectively included. Preoperative physiological AA and NSA were determined via 3-dimensional computed tomography. Linear regressions and Pearson's coefficients were calculated to assess the correlation between the femoral NSA and femoral AA. RESULTS A total of 416 hips were divided into 5 subgroups: 99 normal, 143 type I, 71 type II, 63 type III, and 40 type IV hips following the Crowe classification. Dysplastic femurs had significantly higher AAs than normal hips (25.2° vs 31.4° vs 33.3° vs 35.5° vs 41.7°). Significant positive correlations between the AA and NSA were observed in normal (r = 0.635), type I (r = 0.700), type II (r = 0.612), and type III (r = 0.638) hips (P < .001); however, no meaningful correlation was observed in type IV hips (r = 0.218, P = .176). CONCLUSION The NSA and AA correlated positively and significantly in the normal and dysplastic Crowe type I-III hips. The relationship between the NSA and AA indicates torsion of the proximal femur and offers an opportunity for straightforward estimation of AA based on NSA.
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Affiliation(s)
- Yuehao Hu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Hua Ying
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Degang Yu
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Yuanqing Mao
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Mengning Yan
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Yiming Zeng
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
| | - Zanjing Zhai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P R China
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Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees. Knee Surg Sports Traumatol Arthrosc 2022; 30:680-687. [PMID: 33423093 DOI: 10.1007/s00167-020-06426-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls. METHODS Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between "control group" and "HTO group". Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model. RESULTS The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03). CONCLUSION Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation. LEVEL OF EVIDENCE III, retrospective comparative study.
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Veldman HD, Boymans TAEJ, van Steenbergen LN, Heyligers IC. Age-Associated Changes in Proximal Femur Morphology Affect Femoral Component Sizing in Cementless Hip Arthroplasty. Geriatr Orthop Surg Rehabil 2022; 13:21514593221144615. [DOI: 10.1177/21514593221144615] [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: 07/13/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background In cementless hip arthroplasty, the femoral component should obtain firm fixation within the endosteal bone and achieve adequate reconstruction of hip joint biomechanics simultaneously. Previous anatomical studies described age-related changes of the proximal femoral canal, such as canal widening, which theoretically necessitates the use of larger stem sizes in elderly patients. This study examines a potential association between patients’ age at surgery and the implant size of a cementless femoral component. Material and methods A total of 13,423 primary hip arthroplasties with a single cementless stem registered in the Dutch Arthroplasty Register (LROI) were included. Patient characteristics (ie patients’ age, sex, height and weight at time of surgery) and femoral component size were derived. A one-way ANCOVA was used to compare the mean stem size between age groups, and multivariable linear regression analysis was used in order to investigate to which extent ageing impacted stem size. Results Each subsequent age- group (ten-year intervals) had a significantly larger mean stem size than the prior age- group. Multivariable linear regression analysis revealed that age is positively correlated with stem size and that this correlation is more prominent in females than in males (beta = .046, P < .001 and beta = .028, P < .001 respectively). Interpretation Implant size is positively correlated with age, in particular in females and independently from investigated anthropometric characteristics. The present study endorses that the femoral canal morphology is related to patients’ characteristics such as age and sex. The morphology will subsequently influence implant sizing and therefore may have biomechanical and clinical implications.
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Affiliation(s)
- Hidde D. Veldman
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, Netherlands
| | | | | | - Ide C. Heyligers
- Department of Orthopaedic Surgery and Traumatology, Zuyderland Medical Center Heerlen, Netherlands
- School of Health Professions Education, Maastricht University, Netherlands
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Yoshitani J, Kabata T, Kajino Y, Inoue D, Ohmori T, Ueoka K, Yamamuro Y, Taninaka A, Tsuchiya H. Correlation between lag screw route and the ideal insertion point of the intramedullary nail. Sci Rep 2021; 11:13750. [PMID: 34215831 PMCID: PMC8253735 DOI: 10.1038/s41598-021-93348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
Understanding the morphology of the superior aspect of the proximal femur is critical for treating femoral fracture. We assessed the correlation among the ideal insertion point of the femoral nail, femur head-neck axis, and native anteversion. One hundred patients with normal femurs were included in this study. Computed tomography (CT) images of the proximal femur superior aspect and amount of native anteversion were acquired. Generalised Procrustes analysis showed the morphological characteristics of the superior proximal femur according to native anteversion amount. Morphological characteristics were represented by 4 parameters; the correlation between parameters and native anteversion was investigated using CT data. The passing point of the line from the proximal femoral canal parallel to the native anteversion at the greater trochanter was located more posteriorly (mean 35.6%); the passing point of native anteversion was posterior in the femoral neck and head, although the line of the head-neck centre passed more anteriorly at the greater trochanter (mean 67.5%). This posterior translation was significantly associated with native anteversion amount. Morphometric geometric analysis showed that the lag screw could not pass head-neck centre from the nail inserted into proximal femoral canal. Anterior insertion of the nail was needed for positioning the lag screw centre.
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Affiliation(s)
- Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yuki Yamamuro
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Atsushi Taninaka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan
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Mathon P, Micicoi G, Seil R, Kacaoglu B, Cerciello S, Ahmad F, LiArno S, Teitge R, Ollivier M. Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion. Knee Surg Sports Traumatol Arthrosc 2021; 29:1083-1089. [PMID: 32548676 DOI: 10.1007/s00167-020-06096-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals' lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry. METHODS Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant. RESULTS Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008). CONCLUSION The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- P Mathon
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte-Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - G Micicoi
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte-Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.,iULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte D'Azur, Nice, France
| | - R Seil
- Centre Hospitalier Universitaire du Luxembourg, Luxembourg, Luxembourg
| | - B Kacaoglu
- Department of Orthopedic Surgery, Acibadem Altunizade Hospital, Acibadem University, Faculty of Medicine, Tophanelioglu Cad. No: 1, Altunizade, Uskudar, Istanbul, Turkey
| | - S Cerciello
- Marrelli Hospital, Crotone, Italy.,Casa Di Cura Villa Betania, Rome, Italy
| | | | | | - R Teitge
- Detroit Medical Center, 3990 John R St., Detroit, MI, 48201, USA
| | - Matthieu Ollivier
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, Sainte-Marguerite Hospital, Aix Marseille University, APHM, CNRS, ISM, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
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A review on the evolution and characteristics of post-mortem imaging techniques. FORENSIC IMAGING 2020. [DOI: 10.1016/j.fri.2020.200420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Fravel W, Deskins S, Kocher T, Wood S, Bullock M. A Novel Technique to Detect Femoral Shaft Perforation during Direct Anterior Total Hip Arthroplasty. Arthroplast Today 2020; 6:634-637. [PMID: 32995413 PMCID: PMC7502574 DOI: 10.1016/j.artd.2020.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 05/20/2020] [Accepted: 06/19/2020] [Indexed: 10/25/2022] Open
Abstract
Despite its popularity, the direct anterior approach for hip arthroplasty is not without complications. Intraoperative femoral shaft perforation using this approach ranges from 0.8% to 7%. A missed perforation can lead to fracture with the need for further surgery if not detected intraoperatively. We describe a reproducible and cost-effective technique using a plastic Yankauer suction handle to help identify proximal femoral perforations during direct anterior total hip arthroplasty. Careful attention to the visual, tactile, and auditory feedback provided by the suction handle can help ensure the cortical continuity of the proximal femur. Familiarity with relevant surgical anatomy, improving surgical technique, and scrutinizing implant positioning helps minimize the risk of complications during the direct anterior approach.
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Affiliation(s)
- William Fravel
- Department of Orthopaedics, Marshall School of Medicine, Huntington, WV, USA
| | - Seth Deskins
- Department of Orthopaedics, Marshall School of Medicine, Huntington, WV, USA
| | - Tim Kocher
- Department of Orthopaedics, Marshall School of Medicine, Huntington, WV, USA
| | - Samuel Wood
- Department of Orthopaedics, Marshall School of Medicine, Huntington, WV, USA
| | - Matthew Bullock
- Department of Orthopaedics, Marshall School of Medicine, Huntington, WV, USA
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Horberg JV, Tapscott DC, Kurcz BP, O’Rourke RJ, Mikesell TA, Owen TM, Allan DG. Morphology of the Greater Trochanter: An Assessment of Anatomic Variation and Canal Overhang. Arthroplast Today 2020; 6:644-649. [PMID: 32875012 PMCID: PMC7451874 DOI: 10.1016/j.artd.2020.07.020] [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: 04/16/2020] [Revised: 06/30/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
Background Varus malposition is a risk of early failure in total hip arthroplasty. The degree to which the tip of the greater trochanter (GT) overhangs the canal can increase this risk. Although we know proximal femoral anatomy is variable, no study has addressed variations in medial overhang of the GT on plain radiographs. Methods All low anteroposterior pelvis radiographs more than 1 year were reviewed 3 times by 2 orthopaedic surgeons and one radiologist. The canal width (CW) was measured 10 cm below the lesser trochanter. Canal overhang (CO) was defined by the distance between the lateral medullary canal and a parallel line beginning at the most medial aspect of the GT. The overhang index (OI) is defined as the percentage of the canal overhung by the GT. Results The mean CW was 13.5 mm, mean CO 16.4 mm, and mean OI 1.22. Hips were then classified as the following: (A) OI < 0.5 (n = 8), (B) OI 0.5-1.0 (n = 78), (C) OI 1.0-1.5 (n = 191), and (D) OI > 1.5 (n = 68). Intraobserver reliability was excellent for all measures: 0.89 (confidence interval: 0.87-0.91) for CW, 0.96 (0.95-0.97) for CO, and 0.97 (0.97-0.98) for OI. Interobserver reliability was good for CW 0.75 (0.70-0.79) and excellent for CO 0.90 (0.88-0.92) and OI 0.95 (0.94-0.96). Conclusions Variations in the morphology of the proximal femur can predispose to varus component malposition. The degree to which the GT overhangs the canal can be quantified and classified based on plain films. This can aid in preoperative planning and help guide intraoperative proximal femoral preparation.
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Affiliation(s)
- John V. Horberg
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Orthopaedic Center of Illinois, Springfield, IL, USA
- Department of Orthopaedic Surgery, VaTech Carilion Clinic, Roanoke, VA, USA
- Corresponding author. 2574 Creston Avenue SW, Roanoke, VA 24015, USA. Tel.: +1 309 714 0980.
| | - David C. Tapscott
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Brian P. Kurcz
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Ryan J. O’Rourke
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | | | - Trevor M. Owen
- Department of Orthopaedic Surgery, VaTech Carilion Clinic, Roanoke, VA, USA
| | - D. Gordon Allan
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
- Orthopaedic Center of Illinois, Springfield, IL, USA
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Cementless femoral stem fixation and leg-length discrepancy after total hip arthroplasty in different proximal femoral morphological types. INTERNATIONAL ORTHOPAEDICS 2020; 45:891-896. [PMID: 32572540 DOI: 10.1007/s00264-020-04671-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Leg-length changes at total hip arthroplasty (THA) may result from too proximal position of the femoral component, i.e. not being sunk deep enough into the femoral canal due to the size and shape of both medullary canal and implant. Some femoral implants are designed to achieve such fixation in the mediolateral dimension, while others also engage the bone anteroposteriorly. Our aim was to examine the relationship between proximal femoral morphology, osseointegration and leg-length equalization at THA. We asked whether the Dorr classification, femoral cortical index and canal flare index on preoperative radiographs had significant impact on THA aseptic loosening rates and post-operative leg-length discrepancy (LLD). METHODS Literature review included original articles on proximal femoral morphology with post-operative LLD and other clinical outcomes of THA, published in the last decade. Case reports and biomechanical studies without clinical data were excluded. RESULTS Higher femoral cortical index and/or canal flare index (corresponding to the Dorr type A) increases the risk of leg lengthening at THA. This is particularly notable in femoral stems with metaphyseal fixation, where high canal flare index has also been linked to osseointegration failure and implant loosening. On the other hand, lower canal flare index (corresponding to the Dorr type C) is more prevalent in the elderly population and increases late periprosthetic fracture rates and stress shielding. Even the most commonly used cementless femoral stems cannot offer optimal fit to intra-/extramedullary geometry or offset restoration in up to 30% of clinical cases. CONCLUSIONS Femoral morphology can have significant impact on post-operative LLD and osseointegration of cementless THA. Quantitative measurements of the proximal femoral canal may improve the choice of a particular implant and fixation method.
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Griffiths SZ, Post ZD, Buxbaum EJ, Paziuk TM, Orozco FR, Ong AC, Ponzio DY. Predictors of Perioperative Vancouver B Periprosthetic Femoral Fractures Associated With the Direct Anterior Approach to Total Hip Arthroplasty. J Arthroplasty 2020; 35:1407-1411. [PMID: 31902614 DOI: 10.1016/j.arth.2019.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/29/2019] [Accepted: 12/09/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND There is an association between intraoperative and postoperative femoral fractures and the direct anterior approach (DAA) to total hip arthroplasty (THA). The purpose of our study is to identify risk factors for Vancouver B fractures and to establish a predictable timeline for when these occur. METHODS We retrospectively identified patients with Vancouver B periprosthetic femoral fractures (n = 49) after 11,509 elective primary cementless THA procedures through the DAA between 2012 and 2018 at a single institution. Fracture patients were matched to nonfracture patients (n = 267) by date of surgery and surgeon. Clinical and radiographic factors were collected for multivariable analysis to identify predictors of fracture. RESULTS Periprosthetic Vancouver B femoral fracture incidence was 0.4%. 48 (98%) fractures were postoperative. Fractures occurred at an average of 44 days after surgery (range: 1 to 653 days) with >85% of fractures occurring in the first 6 weeks postoperatively. Significant variables predictive of fracture included >3 degrees valgus and >5 degrees varus coronal stem malalignment, Dorr B and C femoral geometry, lower canal flare index (2.75 vs 3.20), advanced age, increased comorbidities, greater stem canal fill, and right-sided procedures. CONCLUSION Despite an overall low rate of Vancouver B perioperative periprosthetic femoral fractures, it is a devastating complication that typically presents within the first 6 weeks after DAA THA surgery. The risk is increased in patients with unfavorable proximal femoral geometry, coronal stem malalignment, advanced age, increased comorbidities, and right-sided procedures.
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Affiliation(s)
| | - Zachary D Post
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Eric J Buxbaum
- Advanced Orthopedics and Sports Medicine Institute, Freehold, NJ
| | - Taylor M Paziuk
- Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, PA
| | - Fabio R Orozco
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Alvin C Ong
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
| | - Danielle Y Ponzio
- Department of Orthopaedic Surgery, The Rothman Institute, Egg Harbor Township, NJ
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