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Fey B, Brenneis M, Stief F, van Drongelen S. Effect of Stem Design and Positioning on the Leg Axis after Total Hip Arthroplasty: A Secondary Analysis. J Clin Med 2024; 13:4453. [PMID: 39124720 PMCID: PMC11313081 DOI: 10.3390/jcm13154453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/10/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: Various parameters, like femoral offset and leg length, are associated with good patient outcomes after total hip arthroplasty. In this prospective study, the effects of stem design, its placement in the proximal femur and the resulting femoral offset on the total leg axis were investigated. Methods: The 27 patients included in this study received biplanar radiography (EOS®, EOS Imaging) with 3D reconstruction using sterEOS® both preoperatively and postoperatively. For all leg alignment parameters obtained from the 3D reconstruction and from measurements using mediCAD, the deltas between the postoperative and preoperative values were determined. Patients were divided into those who received a short-stem prosthesis and those who received a straight-stem prosthesis. Results: The change in femoral offset with the implantation of a short-stem prosthesis was significantly greater than that with the implantation of a straight-stem prosthesis (11.4 ± 5.9 vs. 4.6 ± 7.4 mm, p = 0.014). Compared with the straight-stem implantation, short-stem implantation caused a significantly greater increase in the varus orientation of the leg (-1.4 ± 0.9 vs. -0.4 ± 1.4°, p = 0.048). There was no significant difference in the positioning of the short-stem prosthesis compared to the straight-stem prosthesis in the proximal femur (3.6 ± 3.1 vs. 2.6 ± 1.9°, p = 0.317). Conclusions: These findings substantiate the impact of prosthesis design on offset and leg alignment. The implantation of short-stems is more variable and requires precise planning. Intraoperative non-physiological offset changes and varus deviation of the leg axis should be avoided. Trial registration: This study was retrospectively registered with the German Clinical Trials Register (DRKS) under the number DRKS00015053 on the 1 August 2018.
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Affiliation(s)
- Benjamin Fey
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Marco Brenneis
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Felix Stief
- Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany; (B.F.); (M.B.); (F.S.)
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Trauma Surgery and Orthopedics, University Hospital Frankfurt, Goethe University Frankfurt, Marienburgstr. 2, 60528 Frankfurt, Germany
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White RC, Lach MM, Schmitt DR, Wozniak AW, Brown NM. Risk Factors for Trochanteric Bursitis Following Total Hip Arthroplasty: A Radiographic Analysis. J Arthroplasty 2024:S0883-5403(24)00637-5. [PMID: 38909856 DOI: 10.1016/j.arth.2024.06.036] [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: 02/05/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Trochanteric bursitis (TB) is a prevalent complication following total hip arthroplasty (THA), with increased offset hypothesized as a potential risk factor. This study investigated potential TB predictors in THA patients, including radiographic measurements of offset and leg length, comorbidities, and patient characteristics. METHODS In this retrospective cohort study, all THA patients from a single academic tertiary care center between 2005 and 2021 were reviewed. Exclusion criteria included less than one-year follow-up, osteonecrosis, or fracture. Manual radiographic measurements of offset (acetabular, femoral, and total) and leg length from preoperative and postoperative antero-posterior pelvis X-rays were taken, with scaling using femoral cortical diameter. Univariable and multivariable Cox proportional hazard models were employed to estimate TB risk. RESULTS Of 1,094 patients, 103 (9.4%) developed TB, with a median (Q1, Q3) time to presentation of 41.8 weeks (25.5, 66.9). In univariable models, only sex was associated with increased TB risk, with women exhibiting a 1.79 times increased risk (hazard ratio: 1.79 (1.16, 2.76), P = .009). Changes in acetabular offset, femoral offset, total offset, and leg length between preoperative and postoperative radiographs were not associated with an increased risk of developing TB in the univariate or multivariate models. Furthermore, various offset thresholds were evaluated, with no amount of increased offset showing increased TB risk. CONCLUSIONS This study found no relationship between femoral, acetabular, or total offset and TB following THA. These findings suggest that surgeons may consider adding offset for increased prosthetic stability in high-risk cases. However, given that this is a retrospective study, the authors are not advocating for the routine use of increased offset. The study identified women as a risk factor with a 1.79 times higher TB risk, highlighting the importance of counseling women patients on this heightened risk.
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Affiliation(s)
- Ryan C White
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Maya M Lach
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Daniel R Schmitt
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Amy W Wozniak
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
| | - Nicholas M Brown
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, Illinois
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Stępiński P, Jegierski D, Maciąg G, Maciąg B, Adamska O, Stolarczyk A. Is There Safety Outside the "Safe Zone" in Total Hip Replacement? A Retrospective Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:772. [PMID: 38792955 PMCID: PMC11123271 DOI: 10.3390/medicina60050772] [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: 04/02/2024] [Revised: 04/24/2024] [Accepted: 05/05/2024] [Indexed: 05/26/2024]
Abstract
Background and Objectives: The safe zone in total hip replacement was introduced many years ago. Its aim was to provide guidelines for orthopedic surgeons in order to avoid complications such as instability. With the growing interest in spinopelvic alignment, some new insights suggest that the safe zone is an obsolete concept. This study aims to show that, even outside the safe zone, the effect of total hip replacement can be satisfactory. This could be used as preliminary study for an analysis of a larger group. Materials and Methods: Fifty-nine consecutive patients with end-stage osteoarthritis treated by total hip replacement were enrolled into the study and divided into two groups: inside the safe zone and outside the safe zone. A physical examination during postoperative visits was performed; the range of movement was measured using a goniometer; and the HHS and VAS were taken to measure functional outcomes and pain, respectively. An analysis of the radiological outcomes was performed. Results: There was no significant difference in regard to changes in total offset, pain, HHS and other complications. There were no signs of instability among patients during the follow-up. Conclusions: The results of this study show that the "safe zone" is a more complicated term that was previously thought. A proper soft tissue balance and spinopelvic alignment could be factors that change the "safe zone" for each patient and make it more individual.
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Affiliation(s)
- Piotr Stępiński
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Dawid Jegierski
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Grzegorz Maciąg
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (G.M.); (O.A.)
| | - Bartosz Maciąg
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
| | - Olga Adamska
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland; (G.M.); (O.A.)
| | - Artur Stolarczyk
- Clinic for Orthopedics and Rehabilitation, Medical University of Warsaw, 04-749 Warsaw, Poland; (D.J.); (B.M.); (A.S.)
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Sang W, Lai P, Xu X, Liu Y, Ma J, Zhu L. Radiographic study of direct anterior approach hip arthroplasty: a 10-15 year follow-up of Chinese patients. ARTHROPLASTY 2024; 6:25. [PMID: 38698494 PMCID: PMC11067169 DOI: 10.1186/s42836-024-00249-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/12/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Controversy remains over whether different surgical approaches exert an impact on the component positioning in total hip arthroplasty. We conducted a retrospective study to reveal the long-term position of prostheses in the first group of patients in China who underwent direct anterior hip arthroplasty. METHODS Collected were data from 350 patients who underwent direct anterior hip arthroplasty between 2008 and 2013, including demographic information, imaging data, Harris hip scores, and surgical complications. Variables, measured radiographically or by CT, included hip offset, leg length discrepancy, component position, and stability within one week after surgery and at the last follow-up. The data were subjected to statistical analysis by using paired t-tests and Pearson chi-square tests. RESULTS Data were harvested by follow-up and self-reported questionnaires. The postoperative follow-up lasted for 13.1 years on average (minimum, 10 years; maximum, 15 years), and the overall survival rate of hip prostheses was 96.3%. The mean Harris score at the final follow-up was 91.8 points. After excluding patients with significant preoperative hip deformities, the incidence of postoperative limb inequality (> 5 mm) was 4.9% at the last follow-up, and the incidence of hip offset discrepancy (> 5 mm) was 14.6%. The overall proportion of the acetabular components located in the Lewinnek safe zone was 77.7%, whereas the proportion of femoral prostheses in the safe zone (< 3° inclination) was 94.0%. Based on the revised data and the last follow-up imaging, the total proportion of acetabular and femoral prostheses with a radiolucence of > 2 mm was 5.1%. CONCLUSION Direct anterior approach hip arthroplasty could achieve excellent component positioning and long-term prosthesis survival in patients without severe hip deformities.
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Affiliation(s)
- Weilin Sang
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Peng Lai
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Xun Xu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Yu Liu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China
| | - Jinzhong Ma
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
| | - Libo Zhu
- Department of Orthopaedics, Shanghai General Hospital, Shanghai, 201620, China.
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Washburn F, Mushaben J, Eichenseer C, Sanderson B, Tran B, Golden T. Perioperative periprosthetic femur fracture associated with direct anterior total hip arthroplasty using metaphyseal fit and fill stem. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:869-877. [PMID: 37750976 PMCID: PMC10858129 DOI: 10.1007/s00590-023-03682-z] [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: 03/16/2023] [Accepted: 08/13/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION This study aims to identify radiographic and clinical risk factors of perioperative periprosthetic femur fracture associated with the direct anterior approach (DAA) using a metaphyseal fit and fill stem. We hypothesize stem malalignment with this femoral implant places increased stress on the medial calcar region, which leads to an increased risk of periprosthetic fracture. METHODS We compared patients with periprosthetic femur fractures following DAA total hip arthroplasty (THA) utilizing the Echo Bi-Metric Microplasty Stem (Zimmer Biomet, Warsaw, IN) to a cohort of patients who did not sustain a periprosthetic fracture from five orthopedic surgeons over four years. Postoperative radiographs were evaluated for stem alignment, neck cut level, Dorr classification, and the presence of radiographic pannus. Univariate and logistic regression analyses were performed. Demographic and categorical variables were also analyzed. RESULTS Fourteen hips sustained femur fractures, including nine Vancouver B2 and five AG fractures. Valgus stem malalignment, proud stems, extended offset, and patients with enlarged radiographic pannus reached statistical significance for increased fracture risk. Low femoral neck cut showed a trend toward statistical significance. CONCLUSION Patients undergoing DAA THA using a metaphyseal fit and fill stem may be at increased risk of perioperative periprosthetic fracture when the femoral stem sits proudly in valgus malalignment with extended offset and when an enlarged pannus is seen radiographically. This study identifies a specific pattern in the Vancouver B2 fracture cohort with regard to injury mechanism, time of injury, and fracture pattern, which may be attributed to coronal malalignment of the implant.
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Affiliation(s)
- Frederic Washburn
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA.
| | - Jacob Mushaben
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Clayton Eichenseer
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Brent Sanderson
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Britni Tran
- Graduate Medical Education, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
| | - Thomas Golden
- Department of Orthopedics, Community Memorial Hospital, 147 Brent St., Ventura, CA, 93003, USA
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Weißenberger M, Heinz T, Rak D, Stratos I, Anderson PM, Lüdemann M, Horas K, Jakuscheit A, Rudert M. Does Body Mass Index (BMI) Affect the Reconstruction of Biomechanical Parameters in Patients Undergoing Total Hip Replacement (THR) through the Direct Anterior Approach (DAA)? J Clin Med 2024; 13:467. [PMID: 38256601 PMCID: PMC10816045 DOI: 10.3390/jcm13020467] [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: 12/19/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
OBJECTIVE Direct anterior approach total hip replacement (DAA-THR) is gaining increased interest due to its tissue-sparing nature and rapid recovery. Obesity has been shown to be a significant parameter influencing cup positioning in DAA-THR. It was the intention of this retrospective study to examine how obesity would influence the restoration of native hip biomechanical parameters during DAA-THR. MATERIALS AND METHODS A total of 74 patients from a high-volume university orthopedic center after unilateral DAA-THA were included. Patients were retrospectively allocated to a study group (BMI > 30 kg/m2) and a control group (BMI < 30 kg/m2). Furthermore, propensity-score matching for baseline parameters was performed, leaving 30 patients in each group. Biomechanical parameters of the hip (i.e., femoral offset (FO), abductor lever arm (ABL), acetabular offset (AO), center of rotation (COR), stem alignment (SA), body weight lever arm (BWL), cup inclination (CI), and leg length discrepancy (LLD) were evaluated on standardized plain radiographs, and parameters were compared to the native contralateral hip. RESULTS Mean BMI in the study group was 35.07 ± 5.13 kg/m2 and 25.43 ± 2.64 kg/m2 in the control group. There was a significant decrease of the ABL only in the study cohort (p = 0.01). CI and SA did not differ between both cohorts. FO was slightly increased compared to the native hip in both groups. There was a marginally higher but non-significant proportion of improper FO restoration in the study group (19 vs. 16 patients, p = 0.60). CONCLUSIONS Obesity, as quantified by BMI, only has a limited impact on the adequate reconstruction of native biomechanical parameters of the hip during DAA-THR. ABL was the only parameter to be significantly decreased in the overweight patients after DAA-THR. Therefore, special care should be taken on proper acetabular reaming and consequent seating of the cup in the obese patient to avoid excessive lateral positioning.
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Affiliation(s)
- Manuel Weißenberger
- Department of Orthopaedic Surgery, University of Wuerzburg, Koenig-Ludwig-Haus, Brettreichstr 11, 97074 Wuerzburg, Germany (I.S.); (P.M.A.); (M.L.); (K.H.); (A.J.)
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Bahl JS, Arnold JB, Saxby DJ, Taylor M, Solomon LB, Thewlis D. The effect of surgical change to hip geometry on hip biomechanics after primary total hip arthroplasty. J Orthop Res 2023; 41:1240-1247. [PMID: 36200414 PMCID: PMC10947254 DOI: 10.1002/jor.25455] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine the effect of surgical change to the acetabular offset and femoral offset on the abductor muscle and hip contact forces after primary total hip arthroplasty (THA) using computational methods. Thirty-five patients undergoing primary THA were recruited. Patients underwent a computed tomography scan of their pelvis and hip, and underwent gait analysis pre- and 6-months postoperatively. Surgically induced changes in acetabular and femoral offset were used to inform a musculoskeletal model to estimated abductor muscle and hip joint contact forces. Two experiments were performed: (1) influence of changes in hip geometry on hip biomechanics with preoperative kinematics; and (2) influence of changes in hip geometry on hip biomechanics with postoperative kinematics. Superior and medial placement of the hip centre of rotation during THA was most influential in reducing hip contact forces, predicting 63% of the variance (p < 0.001). When comparing the preoperative geometry and kinematics model, with postoperative geometry and kinematics, hip contact forces increased after surgery (0.68 BW, p = 0.001). Increasing the abductor lever arm reduced abductor muscle force by 28% (p < 0.001) and resultant hip contact force by 17% (0.6 BW, p = 0.003), with both preoperative and postoperative kinematics. Failure to increase abductor lever arm increased resultant hip contact force 11% (0.33 BW, p < 0.001). In conclusion, increasing the abductor lever arm provides a substantial biomechanical benefit to reduce hip abductor and resultant hip joint contact forces. The magnitude of this effect is equivalent to the average increase in hip contact force seen with improved gait from pre-to post-surgery.
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Affiliation(s)
- Jasvir S. Bahl
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
| | - John B. Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance UnitUniversity of South AustraliaAdelaideAustralia
- IIMPACT in Health, Allied Health & Human Performance UnitUniversity of South AustraliaAdelaideAustralia
| | - David J. Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Mark Taylor
- Medical Device Research Institute, College of Science and EngineeringFlinders UniversityAdelaideAustralia
| | - Lucian B. Solomon
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
| | - Dominic Thewlis
- Centre for Orthopaedic and Trauma Research (COTR), Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
- Department of Orthopaedics and TraumaRoyal Adelaide HospitalAdelaideAustralia
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Peng L, Zeng Y, Wu Y, Si H, Pei F, Shen B. Radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty: a retrospective study with propensity score matching. Arch Orthop Trauma Surg 2022; 142:3995-4005. [PMID: 34821944 DOI: 10.1007/s00402-021-04263-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Dislocation is a complicated process and associated with multivariate etiology and risk factors. The purpose of this study was to verify if radiologic restoration inaccuracy increases postoperative dislocation in primary total hip arthroplasty (THA) individually or synergistically. METHODS From 2017 to 2020, we identified 76 (1.9%) patients who suffered postoperative dislocations from 3926 THAs in our institution. After excluded patients with previously proven patient-related and implant-related risk factors, the remaining patients were used to match a 1:1 control patients who were without dislocation. The cup position (inclination and anteversion angles), hip offset (HO), leg length discrepancy (LLD), and abductor lever arm (ALA) were analyzed by univariate analyses and multivariate logistic regressions. RESULTS Measurements on radiographs showed excellent interobserver agreement (intraclass correlation coefficient (ICC) 0.922-0.952) and intraobserver agreements (ICC 0.933-0.967). HO restoration inaccuracy (without ± 5 mm) was associated with higher dislocation risk (OR 4.241 95% CI 1.440-12.492, P = 0.009). The restoration inaccuracy of the cup position, LLD, or ALA could not increase the dislocation risk individually. When combining the radiologic restoration inaccuracy factors, the HO + LLD restoration inaccuracy and HO + ALA restoration inaccuracy increased the odds of postoperative dislocation (OR 12.056, 95% CI 1.409-103.127, P = 0.023; OR 4.770, 95% CI 1.336-17.028, P = 0.016, respectively). Combining the four risk factors of cup safe zone, HO, LLD, and ALA, patients with 3 or 4 radiologic restoration inaccuracy factors showed a higher risk of dislocation (OR 13.500, 95% CI 1.340-135.983, P = 0.027). CONCLUSION Hip offset (HO) restoration inaccuracy increased the risk of dislocation following primary THA. Multivariate radiologic restoration accuracy is critical for the prevention of dislocation and needs to be valued by surgeons.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, Sichuan Province, 610041, People's Republic of China.
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İncesoy MA, Seluk S, Turk OI, Ezici A, Mert M, Misir A. Anatomical Parameters Associated with the Shortening Decision in Crowe Type 4 Dysplastic Hip Osteoarthritis: A Case-Control Study. Indian J Orthop 2022; 56:1958-1968. [PMID: 36310550 PMCID: PMC9561441 DOI: 10.1007/s43465-022-00708-2] [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: 03/06/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
Background Muscle and bone morphometry may be potent indicators for predicting femoral subtrochanteric shortening osteotomy (FSSO). We aimed to investigate muscular and bony factors that may be predictive of FSSO. Methods Patients with unilateral Crowe type 4 developmental dysplasia of the hip (DDH) who underwent unilateral total hip arthroplasty (THA) without (Group 1, 31 patients) and with FSSO (Group 2, 39 patients) were included. Sixty healthy hips (Group 3) were selected as the control group. Several muscular and bony parameters were measured on the operative (O) and non-operative (NO) hips on radiographs and computed tomography (CT) images. Results The mean NO gluteus medius cross-sectional area (CSA) index (NO-GMed CI), NO tensor fasia lata (TFL) CI, NO iliopsoas (IP) CI, and NO gluteus maximus (GMax) CI for the control group were lower than those for both Crowe type IV DDH with and without FSSO. The mean NO gluteus minimus CI (NO-GMin CI) for the control group were higher than those for both Crowe type IV DDH with and without FSSO. There was significant difference between Groups 1 and 2 regarding axial position of neo-acetabulum (APNA) (- 0.03 ± 8.5 vs. 5.27 ± 6.33, p = 0.004), coronal position of neo-acetabulum (CPNA) (33.39 ± 10.65 vs. 53.70 ± 12.27, p = 0.000), operative leg length discrepancy (O-LLD) (14.18 ± 15.14 vs. 24.44 ± 15.80, p = 0.001), O-gluteus minimus (GMin) length (155.34 ± 157.73 vs. 106.79 ± 20, p = < 0.01), and O-GMin CI (57.28 ± 58.59 vs. 29.95 ± 12.13, p = < 0.01). The cutoff values determined by the receiving operating curve analyses were as follows: 13.7 mm, 2.5 mm, and 41.4 mm for O-LLD, APNA, and CPNA, respectively. Conclusion FSSO is associated with APNA, CPNA, O-LLD, O-GMin length, and O-GMin CI. By using cutoff values of APNA, CPNA, and O-LLD, predicting FSSO preoperatively is possible. Owing to these parameters, it may be possible to lower the technically demanding level of surgery.
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Affiliation(s)
- Mustafa Alper İncesoy
- Department of Orthopedics, Adiyaman Training and Research Hospital, Yunus Emre Mahallesi, 1164. Sk. No: 13, Adiyaman, Turkey
| | - Sefa Seluk
- Department of Orthopedics, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Rumeli Hisari Sok. No. 62, Baltalimani Sariyer, 34470 Istanbul, Turkey
| | - Ozgur Ismail Turk
- Department of Orthopedics, Istanbul Cevre Hospital, Cemal Sahir Sok. No. 2, Mecidiyekoy Sisli, 34394 Istanbul, Turkey
| | - Atakan Ezici
- Department of Orthopedics, Adiyaman Kahta State Hospital, Yavuz Selim District, Hastane Cd No: 39, Kahta, 02400 Adiyaman, Turkey
| | - Muhammet Mert
- Department of Orthopedics, Health Science University Baltalimani Bone Diseases Education and Research Hospital, Rumeli Hisari Sok. No. 62, Baltalimani Sariyer, 34470 Istanbul, Turkey
| | - Abdulhamit Misir
- Department of Orthopedics, Istanbul Medicana Health Group, Beylikduzu Cd, No. 3, Beylikduzu, 34520 Istanbul, Turkey
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Guan H, Xu C, Fu J, Yang X, Zhang Y, Chen J. Ankylosing Spondylitis Patients Have Lower Risk of Dislocation Following Total Hip Arthroplasty Compared with Patients Undergoing Lumbar Spinal Fusion Surgery. Int J Gen Med 2022; 15:6573-6582. [PMID: 35978732 PMCID: PMC9377400 DOI: 10.2147/ijgm.s373432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Patients undergoing lumbar spinal fusion (LSF) surgery and patients with ankylosing spondylitis (AS) have concomitant pathology of hip and lumbosacral spine. The purpose of our study is to compare the dislocation rate following total hip arthroplasty (THA) between patients with LSF and AS and reveal the differences of lumbar fusion secondary to LSF and AS. Patients and methods Fifty-nine patients (73 hips) were included in Group LSF and every patient was matched with two patients in Group AS. Follow-ups were conducted for information of surgical prognosis and dislocation events following THA. Multiple anatomic parameters were measured on preoperative and postoperative radiological images. Results The dislocation rate of patients in Group AS (0.68%) was obviously lower than that of patients in Group LSF (4.11%) and the hazard ratio of dislocation events following THA reached 6.1. Considering the low calculated power (1-β, 0.24), we supposed insufficient statistical evidence (p=0.118) could be attributed to small sample size. Postoperative hip flexion range of motion (ROM) in Group AS (102.1°±24.5°) was significantly lower than that in Group LSF (117.4°±14.2°) (p<0.0005). Postoperative flexion ROM of lumbar was also significantly lower in Group AS (p<0.001). There was no significant difference between two groups concerning postoperative acetabular inclination (p=0.988) and anteversion (p=0.25). However, patients in Group AS had a significantly lower sacral slope (p=0.025) and higher pelvic tilt (p<0.0005) than patients in Group LSF after THA. Conclusion Patients with AS have a lower risk of dislocation after THA compared with patients undergoing LSF. The lower risk is significantly relevant to severer stiffness and lower mobility along the spine-pelvis--hip axis in AS patients after THA. Acetabular orientation has no significant effect on the difference of dislocation rate between patients with LSF and AS.
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Affiliation(s)
- Haitao Guan
- School of Medicine, Nankai University, Tianjin, People's Republic of China.,Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Chi Xu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Fu
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Xue Yang
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Yingze Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jiying Chen
- Department of Orthopedic Surgery, Chinese PLA General Hospital, Beijing, People's Republic of China
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11
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Hu Y, Zou D, Sun Q, Jiang M, Li H, Tsai TY, Zhang J. Postoperative Hip Center Position Associated With the Range of Internal Rotation and Extension During Gait in Hip Dysplasia Patients After Total Hip Arthroplasty. Front Bioeng Biotechnol 2022; 10:831647. [PMID: 35295644 PMCID: PMC8918532 DOI: 10.3389/fbioe.2022.831647] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/03/2022] [Indexed: 12/13/2022] Open
Abstract
Background: Total hip arthroplasty (THA) for hip dysplasia patients is sometimes complex and compromises pathomorphological changes in these patients. However, it remains unclear whether it is preoperative deformities or postoperative structures or anatomic changes during THA that have the most remarkable correlation with the hip dynamic function during gait. The purpose of this study was to investigate this relationship and propose insights into the surgical reconstruction strategy in patients with developmental dysplasia of the hip.Methods: A total of 21 unilateral hip dysplasia patients received computed tomography scans for the creation of 3D hip models before surgery and at the last follow-up. Acetabular and femoral orientations, hip center positions, and femoral length were measured before and after THA. Hip kinematics of the operated side during gait was quantified using a dual fluoroscopic imaging technique. Pearson correlation and multiple linear regression were performed to evaluate the relationship between hip maximum range of motion in six directions and demographics characters and above hip anatomic parameters before and after THA and their changes in surgery.Results: Pearson correlation analysis found significant correlations with the gait range of motion mainly in postoperative structures, including postoperative hip center positions and acetabulum and combined anteversion. Further multiple linear regression indicated that a laterally placed hip center was significantly correlated with an increased internal rotation (R2 = 0.25, p = 0.021), which together with increased postoperative acetabulum anteversion explained 45% of external rotation decreasing (p = 0.004). A proximally placed hip center was correlated with more extension (R2 = 0.30, p = 0.010). No significant demographic characters or preoperative deformities or surgical changes were included into other multiple regression models.Conclusion: Strong correlations between postoperative structures, especially hip center positions and gait range of motion in unilateral hip dysplasia patients after THA were found. It indicated that postoperative prosthesis structures, particularly hip center positions had significant impact on the hip gait motion range and should be treated with particular caution in surgery.
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Affiliation(s)
- Yi Hu
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Diyang Zou
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Sun
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengda Jiang
- Department of Radiology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwu Li
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
| | - Tsung-Yuan Tsai
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China
- TaoImage Medical Technologies Corporation, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
| | - Jingwei Zhang
- Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Huiwu Li, ; Tsung-Yuan Tsai, ; Jingwei Zhang,
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12
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Belyea CM, Lansford JL, Yim DG. Utility of Intraoperative Fluoroscopic Positioning of Total Hip Arthroplasty Components Using a Posterior and Direct Anterior Approach. Mil Med 2022; 187:e11-e16. [PMID: 33231690 DOI: 10.1093/milmed/usaa415] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/27/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Positioning of implant components for total hip arthroplasty (THA) is important for polyethylene liner wear, prosthesis joint stability, and range of motion. The introduction of fluoroscopy for the direct anterior approach has been shown to improve physician accuracy for component positioning. Few studies compare the use of intraoperative fluoroscopy for THA component positioning in posterior THA. The purpose of this project is to retrospectively evaluate the effect of intraoperative fluoroscopy on component positioning for THA using posterior and direct anterior approach (DAA). MATERIALS AND METHODS A retrospective review of postoperative weight-bearing X-ray films of THAs was performed over a 2-year period where a single fellowship-trained total joint surgeon introduced direct anterior approach into his practice while expanding the intraoperative use of fluoroscopy for all THA procedures, regardless of approach. Component position was evaluated through radiographic measurement of acetabular cup inclination (goal of 40 degrees), limb length discrepancy (goal of 0 mm), and femoral component offset difference (goal of 0 mm). Radiographic analysis was performed by two independent providers. Statistical analysis was performed using Student's t-tests. RESULTS A total of 107 patients with an average age of 62 years were identified during the 2-year period surrounding the THA practice change, adding fluoroscopy to posterior and DAA THA. Three cohorts were identified: cohort A: 44 patients who underwent posterior THAs without the use of intraoperative fluoroscopy, cohort B: 35 patients who underwent direct anterior approach THAs with the use of intraoperative fluoroscopy, and cohort C: 18 patients who underwent posterior THAs with the use of intraoperative fluoroscopy. The use of intraoperative fluoroscopy for the posterior approach versus unguided posterior approach increased accuracy of both cup inclination (44 degrees vs 50 degrees, P < .05) and femoral offset (4 mm vs 7 mm, P < .05). A comparison of DAA with fluoroscopy versus posterior approach without fluoroscopy showed improvement in cup inclination (48 degrees vs 50 degrees, P < .05). Fluoroscopy with posterior approach versus fluoroscopy with DAA was found to have improved cup inclination (44 degrees vs 48 degrees, P < .05). CONCLUSION Intraoperative use of fluoroscopy can improve component positioning for posterior THA.
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Affiliation(s)
- Christopher M Belyea
- Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USA
| | - Jefferson L Lansford
- Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
| | - Duke G Yim
- Department of Orthopaedic Surgery, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI 96859, USA
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13
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Andronic O, Rahm S, Fritz B, Singh S, Sutter R, Zingg PO. External snapping hip syndrome is associated with an increased femoral offset. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1481-1489. [PMID: 34550475 PMCID: PMC9587962 DOI: 10.1007/s00590-021-03123-9] [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: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sarvpreet Singh
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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14
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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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15
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Kim SS, Kim HJ, Shim CH. Relationships between Femoral Offset Change and Clinical Score following Bipolar Hip Arthroplasty in Femoral Neck Fractures. Hip Pelvis 2021; 33:78-86. [PMID: 34141694 PMCID: PMC8190501 DOI: 10.5371/hp.2021.33.2.78] [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: 11/29/2020] [Revised: 01/08/2021] [Accepted: 01/09/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aimed to investigate the relationship between femoral offset (FO) and clinical outcomes of patients with femoral neck fracture following bipolar hip arthroplasty (BHA). Materials and Methods Records for a total of 520 patients who underwent BHA for a femoral neck fracture between December 1, 2003, and September 30, 2018, were reviewed retrospectively. Patients with unclear medical records, a congenital deformity and preoperative trauma history of the hip, high-energy multiple trauma, or a history of neurodegenerative disease or cerebrovascular disease were excluded. The remaining 77 patients included in the analysis had a minimum follow-up period of one year. For clinical assessment, the postoperative pain visual analogue scale (VAS) and Harris hip score (HHS) were analyzed at each follow-up period. For radiological assessment, the difference in leg length discrepancy (LLD) and FO were measured. Results The difference in mean FO postoperatively was 6.7±4.8 mm, and the difference in mean postoperative LLD was 4.9±3.4 mm. The mean HHS was 77.1±7.7, 82.3±8.6, 83.4±7.7, and 86.4±6.7 at 1, 3, 6, and 12 months postoperative, respectively. The correlation coefficient between FO and HHS in 1-year follow-up was −0.38, and a statistically significant outcome was found (P=0.001). For the HHS domain, the correlation coefficient for function at 1-year follow-up was −0.42, revealing a statistically significant outcome (P=0.0001). Conclusion There was a statistically significant correlation between clinical outcomes and FO difference at 1 year after BHA in patients over 65 years of age with femoral neck fractures.
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Affiliation(s)
- Sung Soo Kim
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Hyeon Jun Kim
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Chang Heon Shim
- Department of Orthopedic Surgery, College of Medicine, Dong-A University, Busan, Korea
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16
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Haversath M, Lichetzki M, Serong S, Busch A, Landgraeber S, Jäger M, Tassemeier T. The direct anterior approach provokes varus stem alignment when using a collarless straight tapered stem. Arch Orthop Trauma Surg 2021; 141:891-897. [PMID: 32474699 DOI: 10.1007/s00402-020-03457-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inaccurate stem implantation can cause unsatisfactory offset reconstruction and may result in insufficient gluteal muscle function or aseptic loosening. In this study, stem alignment of a collarless straight tapered HA-coated stem was retrospectively analyzed during the learning phase of the direct anterior approach (DAA) for primary total hip arthroplasty (THA). MATERIAL AND METHODS From Jan 2013 to Jun 2015, a total of 93 cementless THA were implanted in patients with unilateral coxarthrosis via the DAA in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Varus(+)/Valgus(-) stem alignment was analyzed in postoperative anteroposterior pelvic radiographs. Effects on femoral offset reconstruction and correlation to patient's individual clinical and radiological parameters were evaluated. RESULTS 55 stems were implanted in varus (59%), 32 in neutral (34%) and 6 in valgus alignment (7%). Mean stem alignment in varus position was + 2.2° (SD ± 1.4°). Varus alignment was associated with male gender and preoperative coxa vara deformity: low CCD, high femoral offset and long thigh neck (p ≤ 0.001). Alignment was not correlated to femoral offset restoration, BMI or leg length difference. Mean cup inclination was 44° (SD ± 4.7°) and 90% matched the coronal Lewinnek safe zone. CONCLUSION In the learning curve, the DAA can be associated with a high incidence of varus stem alignment when using a straight tapered stem, especially in men with coxa vara deformity: low CCD, high femoral offset and long thigh neck. An insufficient capsule release makes femur exposure more difficult and might be an additional factor for this finding. We recommend intraoperative X-ray in the learning phase of the DAA to verify correct implant positioning and to adjust offset options.
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Affiliation(s)
- Marcel Haversath
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany.
| | - Martin Lichetzki
- Medical Faculty, University of Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Germany
| | - Sebastian Serong
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - André Busch
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim a.d. Ruhr, 45468, Mülheim an der Ruhr, Germany
| | - Stefan Landgraeber
- Department of Orthopaedics, St. Vinzenz-Krankenhaus, Schloßstraße 85, 40477, Düsseldorf, Germany
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
| | - Marcus Jäger
- Department of Orthopaedics, Trauma and Reconstructive Surgery, St. Marien-Hospital Mülheim a.d. Ruhr, 45468, Mülheim an der Ruhr, Germany
| | - Tjark Tassemeier
- Gelenkzentrum Bergisch Land, Freiheitstraße 203, 42853, Remscheid, Germany
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17
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Hu X, Zheng N, Chen Y, Dai K, Dimitriou D, Li H, Tsai TY. Optimizing the Femoral Offset for Restoring Physiological Hip Muscle Function in Patients With Total Hip Arthroplasty. Front Bioeng Biotechnol 2021; 9:645019. [PMID: 33869155 PMCID: PMC8045972 DOI: 10.3389/fbioe.2021.645019] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/19/2021] [Indexed: 12/27/2022] Open
Abstract
Objective Femoral offset (FO) restoration is significantly correlated with functional recovery following total hip arthroplasty (THA). Accurately assessing the effects of FO changes on hip muscles following THA would help improve function and optimize functional outcomes. The present study aimed to (1) identify the impact of FO side difference on the hip muscle moment arms following unilateral THA during gait and (2) propose the optimal FO for a physiological hip muscle function. Methods In vivo hip kinematics from eighteen unilateral THA patients during gait were measured with a dual-fluoroscopic imaging system. The moment arms of thirteen hip muscles were calculated using CT-based 3D musculoskeletal models with the hip muscles’ lines of actions. The correlation coefficient (R) between FO and hip muscle moment arm changes compared with the non-implanted hip was calculated. We considered that the FO reconstruction was satisfactory when the abductor moment arms increased, while the extensor, adductor, and flexor moment arms decreased less than 5%. Results A decreased FO following THA was significantly correlated with a decrease of the abductor and external rotator moment arms during the whole gait (R > 0.5) and a decrease of extensor moment arms during the stance phase (R > 0.4). An increased FO following THA was significantly associated with shorter flexor moment arms throughout the gait (R < −0.5) and shorter adductor moment arms in the stance phase (R < −0.4). An increase in FO of 2.3–2.9 mm resulted in increased abductor moment arms while maintaining the maximum decrease of the hip muscles at less than 5.0%. Conclusion An increase of 2–3 mm in FO could improve the abductor and external rotator function following a THA. Accurate surgical planning with optimal FO reconstruction is essential to restoring normal hip muscle function in THA patients.
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Affiliation(s)
- Xiangjun Hu
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kerong Dai
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopaedics, Bürgerspital Solothurn, Solothurn, Switzerland
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants, Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Abductor Muscle Force after Straight-Stem Compared to Short-Stem Total Hip Arthroplasty through a Modified Direct Lateral Approach: Functional Assessment of 70 Consecutive Patients of a Randomized Controlled Clinical Trial. J Clin Med 2021; 10:jcm10061235. [PMID: 33809713 PMCID: PMC8002373 DOI: 10.3390/jcm10061235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 02/26/2021] [Accepted: 03/12/2021] [Indexed: 11/25/2022] Open
Abstract
Because of preservation of proximal femoral bone stock and minimized soft tissue trauma, short-stem implants are becoming increasingly important in total hip arthroplasty (THA). The postulated advantage regarding the functional outcome has not been verified. We hypothesized an increased abductor muscle strength by the use of a short-stem design. Seventy consecutive patients of a randomized clinical trial were included. Of these, 67 patients met the inclusion criteria after 12 months. Thirty-five patients received a standard straight stem and 32 patients a short-stem femoral component. All surgeries were performed by a modified direct lateral approach. Isometric muscle strength of the hip abductors was evaluated preoperatively 3 and 12 months after surgery. Harris hip score (HHS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were evaluated. After three months, there were no differences between the two groups; the abductor force was comparable to the preoperative initial values. After 12 months, a significant increase in muscle strength for the short stem patient group compared to preoperative baseline values was measured (straight-stem THA, 0.09 Nm/kg ± 0.4, p = 0.32; short-stem THA, 0.2 Nm/kg ± 0.3, p = 0.004). Comparison of the 12-month postoperative total HHS and WOMAC revealed no significant differences between both groups. A significant increase in hip abductor muscle strength 12 months after short-stem THA compared to conventional-stem THA was observed.
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TRIANTAFYLLOU ATHANASIOS, PAPAGIANNIS GEORGIOS, STASI SOPHIA, GEORGIOS PAPATHANASIOU, KOULOUVARIS PANAYIOTIS, PAPAGELOPOULOS PANAYIOTISJ, BABIS GEORGEC. BIOMECHANICAL ASSESSMENT OF WEAR IN CERAMIC ON CERAMIC AND CERAMIC ON XLPE THAs. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421500238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Total Hip Arthroplasty (THA) is an effective treatment for severe hip arthritis, with patients reporting high rates of satisfactory results postoperatively. There are a variety of choices regarding THA implant designs. Ceramic on Ceramic and Ceramic on Highly Cross-Linked Polyethylene (XLPE) THAs are the materials of choice nowadays. The purpose of this study is to review the effect of kinematics and kinetics on wear (in vivo and in vitro testing) that affect wear in Ceramic on Ceramic and Ceramic on XLPE total hip arthroplasties and identify possible advantages amongst them. The study hypothesis was that THA kinematics and/or kinetics, since they directly affect THA wear, could provide data for possible advantages between the examined implant designs. A systematic review of the literature identified no significant evidence for biomechanical advantages between these two prostheses in terms of wear. Further research is proposed with the use of gait analysis systems combined with surface electromyography to further investigate THA biomechanics at a laboratory set up. Wearable sensors technology could also identify detailed biomechanical parameters in more complex daily activities.
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Affiliation(s)
- ATHANASIOS TRIANTAFYLLOU
- Orthopaedic Research and Education Center, “P.N.Soukakos” Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital 1st Department of Orthopaedic Surgery, Medical School National and Kapodistrian University of Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Greece
| | - GEORGIOS PAPAGIANNIS
- Orthopaedic Research and Education Center, “P.N.Soukakos” Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital 1st Department of Orthopaedic Surgery, Medical School National and Kapodistrian University of Athens, Greece
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Greece
| | - SOPHIA STASI
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Greece
| | - PAPATHANASIOU GEORGIOS
- Laboratory of Neuromuscular and Cardiovascular Study of Motion, Physiotherapy Department, Faculty of Health and Care Sciences, University of West Attica, Greece
| | - PANAYIOTIS KOULOUVARIS
- Orthopaedic Research and Education Center, “P.N.Soukakos” Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital 1st Department of Orthopaedic Surgery, Medical School National and Kapodistrian University of Athens, Greece
| | - PANAYIOTIS J. PAPAGELOPOULOS
- Orthopaedic Research and Education Center, “P.N.Soukakos” Biomechanics and Gait Analysis Laboratory “Sylvia Ioannou”, “Attikon” University Hospital 1st Department of Orthopaedic Surgery, Medical School National and Kapodistrian University of Athens, Greece
| | - GEORGE C. BABIS
- Konstantopouleio General Hospital, Nea Ionia 2nd Department of Orthopaedic Surgery, Medical School National and Kapodistrian University of Athens, Greece
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20
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Femoral neck shaft angle in relation to the location of femoral stress fracture in young military recruits: femoral head versus femoral neck stress fracture. Skeletal Radiol 2021; 50:1163-1168. [PMID: 33145605 PMCID: PMC8035084 DOI: 10.1007/s00256-020-03661-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/28/2020] [Accepted: 10/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the influences of the femoral neck shaft angle (FNSA) on the location of the femoral stress fracture and to assess the potential differences in FNSA between fractured and normal femurs. MATERIALS AND METHODS Thirty-seven patients with femoral stress fractures who underwent both plain hip radiographs and MRI, from January 2016 to September 2019, were retrospectively included. Patients were classified as having either femoral head stress fracture (group A, n = 26) or femoral neck stress fracture (group B, n = 11). The FNSA was measured in anteroposterior (AP) hip radiograph. The Mann-Whitney U testing was used to compare the continuous values between the two groups. A receiver operating characteristic (ROC) analysis was used to evaluate the value of FNSA for predicting the risk of femoral stress fracture. RESULTS The FNSA was significantly higher in group A (median 135.9°, range 129.5-138.6°) than group B (median 124.3°, range 119.5-129.0°) (p < 0.001), but there were no significant differences in other clinical factors. Furthermore, the FNSA was significantly higher at the fractured femurs (median 135.9°, range 129.9-138.6°) than contralateral normal femurs (median 127.9°, range 123.8-132.1°) in the patients with unilateral femoral head stress fracture (n = 22) (p < 0.001). The ROC analysis revealed that the area under curve (AUC), sensitivity, and specificity for predicting the risk of femoral head stress fracture were 0.807, 72.7%, and 68.2%, respectively, at a FNSA cutoff of 131.0°. CONCLUSION FNSA was associated with the location of the femoral stress fracture. In addition, FNSA could serve as a predictive factor for the risk of femoral head stress fractures.
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Rai AK, Yadav S, Verma V, Anand S, Shekhar S. Analysis of vertical and horizontal offsets in displaced femoral neck fracture in elderly treated with indigenous bicentric bipolar hip device. J Clin Orthop Trauma 2020; 13:143-146. [PMID: 33717886 PMCID: PMC7920007 DOI: 10.1016/j.jcot.2020.11.014] [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: 06/10/2020] [Revised: 10/20/2020] [Accepted: 11/16/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To analyze the effect of indigenous bicentric bipolar prosthesis on horizontal and vertical offsets in fracture neck of femur when compared to contralateral normal hip and to evaluate functional outcomes. We hypothesized that our non-modular bipolar device restores satisfactory offsets in such patients. METHODS All active elderly patients with displaced fracture NOF having contralateral normal hip were included. We used an indigenous bicentric bipolar hip-prosthesis, which is a non-modular single-piece device in all cases by lateral Hardinge approach. Postoperative radiograph AP view was taken in 15° internal rotation to decrease the effect of limb rotation on offset. CT scan was also used to evaluate offsets using ADW4.6 ADVANCED GE optima 128 slice software system. Subjects were followed for a minimum of 12 months postoperatively and functional outcome of effect of offsets change were evaluated by modified Harris Hip Score. RESULTS There is minimal difference in horizontal and vertical offset after bicentric bipolar hemi-replacement which is statistically insignificant supporting our hypothesis. The clinical outcomes were good to fair according to modified Harris Hip Score. The mean value of horizontal offset after our bipolar hemireplacement was 42.4 ± 2.04 mm and of normal hip was 41.8 ± 1.81 mm and P-value=0.08 in plain radiographs and value of horizontal offset in CT scan was 40.73 ± 0.27on bipolar side and 41.19 ± 0.77 on normal side. Vertical offset after bicentric bipolar was 32.67 ± 2.85 mm and vertical offset of normal hip was 32.53 ± 2.73 mm. Mean 9.77 ± 1.09 mm of calcar was preserved. Modified Harris Hip Score at 6 and 12 months postoperatively was 75.78 ± 4.16 and 79.53 ± 3.95 respectively. There was no incidence of hip dislocation. CONCLUSION Our study data clearly demonstrates that vertical and horizontal offsets are effectively maintained by the indigenous bicentric hip device. There was insignificant change in offsets as compared to contralateral normal side due to its design modifications. Indigenous bicentric non-modular bipolar device offers an excellent option for femur neck fractures in elderly patients in resource constrained situations. It allows rapid rehabilitation due to reduced surgical time, minimal blood loss and early return to function and activities of daily living.
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Affiliation(s)
| | - Sanjay Yadav
- Corresponding author. Department of Orthopedics Institute of Medical Sciences, BHU, 221005, India.
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22
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Vaishya R, Vaish A, Ansari AH. Challenges in Total Hip Replacement after McMurray's Osteotomy: A Report of 3 Cases and Review of Literature. Clin Orthop Surg 2020; 12:442-447. [PMID: 33274020 PMCID: PMC7683200 DOI: 10.4055/cios20056] [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: 03/17/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background McMurray's osteotomy of the hip was a popular surgery practiced for almost 5 decades for the management of the fractured neck of the femur and hip osteoarthritis since its first description in 1936. It is an oblique, medial displacement intertrochanteric osteotomy. In the long term, McMurray's osteotomy patients develop limb length discrepancy and secondary osteoarthritis due to the altered biomechanics of the hip and may require total hip replacement (THR). THR after the previous osteotomy is more challenging than that for unoperated hip joints due to severe distortion of the hip anatomy and soft-tissue contractures. These challenges are related to distorted bony anatomy, soft-tissue contractures, and the choice of implants. Methods Three patients with previous McMurray's osteotomy of the hip developed secondary osteoarthritis and underwent total hip replacement. We discussed specific challenges encountered during THR and techniques to deal with such problems. Results All patients had pain-free hip, with minimal residual shortening (average, 1.2 cm) at an average follow-up of 3.67 years (range, 1 to 6 years). The Harris hip score improved significantly postoperatively and no complications were encountered. Conclusions A detailed and careful preoperative planning, correct execution of surgical techniques, and postoperative rehabilitation are the keys to the successful management of these cases.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
| | - Aabid Husain Ansari
- Department of Orthopaedics and Joint Replacement Surgery, Indraprastha Apollo Hospitals, New Delhi, India
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23
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Murphy J, Yusta-Zato J, Patel A, Davies AM, James SL, McBryde C, Botchu R. The use of pelvic radiographs as a predictor for gluteal tendinopathy and bursitis. Hip Int 2020; 30:775-778. [PMID: 31558047 DOI: 10.1177/1120700019878417] [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
AIM To evaluate the relationship between radiographic measurements of the hip and sonographic evidence of gluteal tendinopathy and bursitis in patients with lateral hip pain. METHODS AND MATERIALS Patients with lateral hip pain referred for ultrasound of the hip in our institution over a 5-year period were identified. Findings of gluteal tendinopathy and subgluteal or trochanteric bursitis on ultrasound were recorded. Radiographs of the hip were also evaluated and femoral offset (FO), global offset (GO), abductor lever arm (ALA) and trochanteric impingement distance (TID) were recorded. The mean of each measurement was compared between patients with gluteal tendinopathy and subgluteal or trochanteric bursitis. RESULTS 273 patients were included in the study. 107 patients (39.2%) had a THA. In the asymptomatic hip, a range of normal measurements were obtained: FO 22.4-76.5 mm, GO 40.1-116.1 mm, ALA 45.0-98.4 mm and TID 13.8-63.1 mm. In the native hip and post THA, there was no statistically significant relationship between FO, GO, ALA and TID in patients with gluteal tendinopathy or trochanteric or subgluteal bursitis. CONCLUSIONS Lateral hip pain is a common presenting complaint in patients with hip pain and is reported in a small proportion of patients post THA. No statistically significant relationship was found between radiographic measurements and ultrasound findings in our patient cohort. However, we describe the range of measurements obtained from the normal asymptomatic hip in this large cohort of patients, which may aid in the evaluation and management of patients with lateral hip pain.
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Affiliation(s)
- Jennifer Murphy
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Jose Yusta-Zato
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Anish Patel
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - A Mark Davies
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Steven L James
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Callum McBryde
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Rajesh Botchu
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
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Hu X, Zheng N, Hsu WC, Zhang J, Li H, Chen Y, Dai K, Tsai TY. Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait. J Orthop Surg Res 2020; 15:315. [PMID: 32787875 PMCID: PMC7424990 DOI: 10.1186/s13018-020-01832-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/29/2020] [Indexed: 12/27/2022] Open
Abstract
Background Precise evaluation of the hip abductor and adductor muscles function in total hip arthroplasty (THA) patients during gait could help prevent postoperative complications and optimize the rehabilitation training program. The purpose of this study was to elucidate the effects of THA on the hip abductor and adductor muscle lengths and moment arms of in vivo patients during gait. Methods Ten unilateral THA patients received CT scans and dual fluoroscopic imaging for the hip kinematics during gait. The hip abductor and adductor muscle insertions were digitized on the 3D hip model for the determination of their dynamic lines of action and moment arms. Changes in the hip abductor and adductor muscle lengths and moment arms of THA patients between the implanted and non-implanted sides were quantified during gait. Results The adductor longus, adductor brevis, and pectineus of the implanted hips had significantly (P < 0.05) less elongation than that of the non-implanted side during the stance phase. The gluteus medius, gluteus minimus, and piriformis moment arms of the implanted side were significantly shorter. The piriformis muscle moment arm was significantly larger. In the double support phase, the adductor magnus and adductor longus moment arms of the implanted sides were significantly decreased. Conclusions Results suggested that the adverse effects of THA on hip stability. Development of a rehabilitation program considering the effects of THA is essential. Accurate surgical techniques may reduce the impact of THA on the peripheral muscles.
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Affiliation(s)
- Xiangjun Hu
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Chun Hsu
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Jingwei Zhang
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiwu Li
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunsu Chen
- Department of Orthopaedic, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kerong Dai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University; Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China. .,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Pazarci O, Kilinc S, Camurcu Y, Bulut O. Total hip arthroplasty after hip joint gunshot injury. J Orthop Surg (Hong Kong) 2020; 27:2309499019873113. [PMID: 31496364 DOI: 10.1177/2309499019873113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Gunshot injury of the hip joint was reported to constitute 2-17% of all extremity firearm injuries. However, there are few studies in the literature related to gunshot injuries of the hip joint. The aim of the current study was to present the results of 10 cases treated with arthroplasty following a gunshot injury to the hip joint together with the recommended treatment algorithm. METHODS Patients with a previous medical history of hip joint region gunshot injury who underwent total hip arthroplasty were retrospectively evaluated. Those with incomplete medical records or who were lost to follow-up were excluded. Patients were classified according to the severity of the previous gunshot injury to the hip joint region. Harris hip score (HHS) and Short Form-12 quality of life score were the main outcome measurements. Postoperative complications encountered during follow-up were recorded. RESULTS The mean age of the patients at the time of surgery was 29.9 years. The mean preoperative HHS was 25.2 points and it was 65.8 at the final follow-up. Patients with bullet fragments in the hip joint, classified as group 1, had better HHS, whereas those with contaminated hip joint with intestinal flora, classified as group 3, had worst HHS. CONCLUSION Hip arthroplasty after hip joint gunshot injury is a good treatment choice in young patients to reduce pain and regain functions. However, very high infection rates can be seen in patients with accompanying intestinal injury.
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Affiliation(s)
- Ozhan Pazarci
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Seyran Kilinc
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Yalkin Camurcu
- Department of Orthopaedics and Traumatology, Erzincan University School of Medicine, Erzincan, Turkey
| | - Okay Bulut
- Department of Orthopaedics and Traumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
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Trevisan C, Klumpp R, Piscitello S, Compagnoni R, Grattieri R, Cazzaniga C. Biomechanical reconstruction parameters obtained after direct anterior approach total hip arthroplasty do not compromise clinical outcome. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1463-1470. [PMID: 32613469 DOI: 10.1007/s00590-020-02727-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/25/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Accurate reconstruction of biomechanical parameters following total hip arthroplasty (THA) is crucial for good joint function. We investigated how reconstruction parameters achieved by minimally invasive anterior (MIS) THA may influence function and patient-related outcomes. METHODS A consecutive series of 95 patients treated by MIS THA for primary osteoarthritis were retrospectively reviewed. Primary outcome measures were Harris Hip Score (HHS), hip disability and osteoarthritis outcome score (HOOS) and EQ-5D. Femoral offset (FO), abductor lever arm (ALA), centre of rotation (CoR), leg length discrepancy (LLD), cup version and stem alignment were measured pre- and post-operatively. Obtained reconstruction parameters compared to the contralateral hip were used as independent variables in a multivariate regression with each primary outcome measure as dependent variable. RESULTS Mean age at surgery was 69 years. HHS rated 94.7% of patients as good/excellent and mean EQ-5D was 0.82. Post-operative HOOS subscales showed no statistical difference compared to the Italian benchmark population. Stem alignment averaged 0.2° valgus, mean cup inclination was 37.8° and mean anteversion was 12.8°. When compared to the contralateral side, CoR was post-operatively elevated by 2.6 mm and medialized by 2.4 mm averagely. An average FO reduction of -0.5 mm was observed while FO ratio increased by 1.9% averagely. ALA decreased by -3.3 mm while LLD was 2.3 mm averagely. Multivariate regression analysis revealed a significant contribution of ALA to HHS only. CONCLUSIONS Biomechanical parameters achieved by MIS THA are satisfactory with negligible impact on functional results and no impact on patient-related outcomes certifying the high quality achieved in THA.
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Affiliation(s)
- Carlo Trevisan
- Orthopaedics and Traumatology of the University of Milano-Bicocca, Milano, Italy
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy
| | - Raymond Klumpp
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy.
| | - Stefano Piscitello
- Orthopaedics and Traumatology of the Hospital ASST Bergamo Est, Via Paderno 21, 24068, Seriate (Bergamo), Italy
| | - Riccardo Compagnoni
- Orthopaedics and Traumatology of the University of Milano, ASST "Gaetano Pini"-CTO, Piazza Ferrari 1, 20122, Milano, Italy
| | | | - Carlo Cazzaniga
- Orthopaedics and Traumatology, ASST Rhodense Ospedale Guido Salvini, Viale Forlanini, 95, 20024, Garbagnate Milanese (MI), Italy
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Yao M, Wang Y, Wei C, Han Y, Li H. Greater increase in femoral offset with use of collum femoris-preserving stem than Tri-Lock stem in primary total hip arthroplasty. J Int Med Res 2020; 48:300060520925999. [PMID: 32459103 PMCID: PMC7273761 DOI: 10.1177/0300060520925999] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE This study was performed to compare the clinical outcomes and performance of the collum femoris-preserving (CFP) stem (Waldemar Link GmbH & Co., Hamburg, Germany) and the Tri-Lock stem (DePuy Orthopaedics, Warsaw, IN, USA) in terms of femoral offset (FO) and leg length reconstruction. METHODS Clinical and radiographic data of patients who underwent total hip arthroplasty with either a CFP stem or Tri-Lock stem from January 2016 to March 2017 were compared (65 and 57 patients, respectively). The Harris hip score and Western Ontario and McMaster Universities Osteoarthritis Index were recorded. The FO, femoral vertical offset, and neck-shaft angle were measured at the last follow-up. The occurrence of dislocation and periprosthetic fracture during the follow-up period was recorded. RESULTS The CFP stem induced significantly more FO than did the Tri-Lock stem on the operated side than contralateral side (3.63 ± 4.28 vs. 0.83 ± 5.46 mm). Significantly fewer patients had a >5-mm decrease in FO on the unaffected side in the CFP stem group (n = 1) than Tri-Lock stem group (n = 10). CONCLUSION Both stems similarly improved hip function and reconstructed the leg length, but the CFP stem was superior to the Tri-Lock stem in reconstructing FO.
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Affiliation(s)
- Mengxuan Yao
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yuchuan Wang
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Congcong Wei
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
| | - Huijie Li
- Department of Osteonecrosis and Hip Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, P.R. China
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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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Savov P, Budde S, Tsamassiotis S, Windhagen H, Klintschar M, Ettinger M. Three-dimensional templating in hip arthroplasty: the basis for template-directed instrumentation? Arch Orthop Trauma Surg 2020; 140:827-833. [PMID: 32157370 PMCID: PMC7244460 DOI: 10.1007/s00402-020-03394-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Computed tomography-based three-dimensional models may allow the accurate determination of the center of rotation, lateral and anterior femoral offsets, and the required implant size in total hip arthroplasty. In this cadaver study, the accuracy of anatomical reconstruction was evaluated using a three-dimensional planning tool. MATERIALS AND METHODS A total of eight hip arthroplasties were performed on four bilateral specimens. Based on a computed tomography scan, the position and size of the prosthesis were templated with respect to the anatomical conditions. RESULTS On average, all parameters were reconstructed to an accuracy of 4.5 mm and lie within the limits recommended in the literature. All prostheses were implanted with the templated size. CONCLUSIONS The exact anatomy of the patient and the required size and position of the prosthesis were precisely analyzed using a templating software. Based on the present findings, the development of template-directed instrumentation is conceivable using this method. However, further technical features (e.g., navigation or robot-assisted surgery) are required for improved precision for implant positioning.
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Affiliation(s)
- P. Savov
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Budde
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - S. Tsamassiotis
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - H. Windhagen
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
| | - M. Klintschar
- grid.10423.340000 0000 9529 9877Institute for Forensic Medicine, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hanover, Germany
| | - M. Ettinger
- grid.10423.340000 0000 9529 9877Department of Orthopedic Surgery, Hannover Medical School, Anna-von-Borries-Strasse 1-7, 30625 Hanover, Germany
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Bolink SAAN, Lenguerrand E, Brunton LR, Hinds N, Wylde V, Heyligers IC, Blom AW, Whitehouse MR, Grimm B. The association of leg length and offset reconstruction after total hip arthroplasty with clinical outcomes. Clin Biomech (Bristol, Avon) 2019; 68:89-95. [PMID: 31177011 DOI: 10.1016/j.clinbiomech.2019.05.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/24/2019] [Accepted: 05/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Restoring native hip anatomy and biomechanics is important to create a well-functioning hip arthroplasty. This study investigated the association of hip offset and leg length after hip arthroplasty with clinical outcomes, including patient reported outcome measures, the Trendelenburg Test and gait analysis. METHODS In 77 patients undergoing primary hip arthroplasty for osteoarthritis (age mean = 65 SD = 11 years; BMI mean = 27 SD = 5 kg/m2), hip offset and leg length discrepancy were measured on anteroposterior radiographs. The Western Ontario & McMaster Universities Osteoarthritis Index, the Trendelenburg Test and gait were assessed preoperatively, and at 3 and 12 months postoperatively. An inertial measurement unit was used to derive biomechanical parameters, including spatiotemporal gait parameters and tilt angles of the pelvis. Relationships between radiographic and functional outcomes were investigated, and subgroups of patients with >15% decreased and increased femoral offset were analysed separately. FINDINGS Patient-reported function scores and clinical tests demonstrated a few significant, weak correlations with radiographic outcomes (Spearman's ρ range = 0.26-0.32; p < 0.05). Undercorrection of femoral offset was associated with lower patient-reported function scores and with more step irregularity as well as step asymmetry during gait. Postoperative leg length inequality was associated with increased frontal plane tilt angle of the pelvis during the Trendelenburg Test and increased sagittal plane motion of the pelvis during gait. Femoral offset subgroups demonstrated no significant differences for patient-reported function scores and outcomes of the Trendelenburg Test and gait analysis. INTERPRETATION Reduced hip offset and leg length discrepancy following hip arthroplasty seem to be marginally associated with worse clinical outcomes.
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Affiliation(s)
- Stijn A A N Bolink
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom.
| | - Erik Lenguerrand
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | | | - Nicole Hinds
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Vikki Wylde
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Ide C Heyligers
- Zuyderland Medical Center Heerlen, Dept of Orthopaedics, Henri Dunantstraat 5, 6419 PC Heerlen, the Netherlands
| | - Ashley W Blom
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Michael R Whitehouse
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol BS10 5NB, United Kingdom
| | - Bernd Grimm
- The Human Motion Institute, Hohenlindener Str. 1, 81677 Munich, Germany
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Haversath M, Busch A, Jäger M, Tassemeier T, Brandenburger D, Serong S. The 'critical trochanter angle': a predictor for stem alignment in total hip arthroplasty. J Orthop Surg Res 2019; 14:165. [PMID: 31146787 PMCID: PMC6542108 DOI: 10.1186/s13018-019-1206-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/20/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Stem malalignment can affect offset reconstruction and may result in gluteal muscle insufficiency. In this retrospective study, a novel geometric angle named ‘critical trochanter angle’ (CTA) is described and investigated towards the risk of malposition of a collarless straight tapered hydroxyapatite-coated stem in primary total hip arthroplasty (THA). Material and methods A total of 100 cementless THA were implanted in patients with unilateral coxarthrosis via the direct anterior (n = 50) or direct lateral Hardinge approach (n = 50) in a two surgeon setting using the Corail® or Trendhip® stem (DePuy Synthes or Aesculap). Stem alignment was analysed in postoperative AP pelvic radiographs and correlated to the CTA: the angle crest was defined by the intersection of the femoral shaft and neck axis and the angle was measured between the shaft axis and a leg intersecting the vertex between the lateral and superoposterior facet of the trochanter. Results Forty-seven stems were implanted in varus (≥ + 1°), 42 in neutral (< + 1°/> − 1°) and 11 in valgus position (≤ − 1°). The mean critical trochanter angle was 25.0° (SD ± 7.5°), and there was a negative and statistically significant correlation to stem alignment (r = − 0.52; p ≤ 0.001) independent from the surgical approach. For stem malposition of 2° and above (n = 23), mean CTA was 17.2° for varus (n = 20) and 31.6° for valgus (n = 3). A CTA lesser or equal to 22.75° had a sensitivity of 90% and specificity of 80% for varus stem position of 2° or greater. Specificity raised to 100% with a cutoff CTA of 12.5° or lesser. Conclusion Varus stem alignment in THA is associated with coxa vara deformity and a radiological low CTA. In preoperative planning, the critical trochanter angle can help to evaluate the risk for intraoperative stem malpositioning. If navigation or robotic assistance is not available when using this stem design, we recommend an intraoperative x-ray to verify correct implant positioning in patients with a CTA under 20° or above 30°.
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Affiliation(s)
- Marcel Haversath
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - André Busch
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Marcus Jäger
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Tjark Tassemeier
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Daniel Brandenburger
- Department of Orthopaedics and Trauma Surgery, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sebastian Serong
- Department of Orthopaedics and Orthopaedic Surgery, Saarland University, Homburg, Germany
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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: 40] [Impact Index Per Article: 5.7] [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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Erivan R, Aubret S, Villatte G, Mulliez A, Descamps S, Boisgard S. Does using a polyethylene RM press-fit cup modify the preparation of the acetabulum and acetabular offset in primary hip arthroplasty? Orthop Traumatol Surg Res 2017; 103:669-674. [PMID: 28579018 DOI: 10.1016/j.otsr.2017.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/23/2017] [Accepted: 03/29/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION When performing total hip arthroplasty (THA), it is important to maintain the femoral and acetabular offsets to ensure good joint stability and to restore the function of the hip abductor muscles. In our practice, we mainly use a lateralized stem and hollow out the acetabulum to the quadrilateral plate to accommodate a press-fit polyethylene cup. However, the repercussions of this preparation method, which is driven by the cup's design, are not known. We carried out a retrospective study to assess: (1) the changes in the femoral and acetabular offset; (2) the height of the center of rotation; and (3) the repercussions on wear. HYPOTHESIS We hypothesized there would be no significant differences between the preoperative and postoperative femoral and acetabular offsets. PATIENTS AND METHODS We reviewed 88 primary THA cases performed with the RM Pressfit™ cup that had a minimum of 5 years' follow-up. A lateralized self-locking Muller-type cemented femoral stem was used in 92.0% of cases and a standard stem in 8.0%. Measurements were done on plain radiographs with MHP™ and Mesurim Pro™ software. The average follow-up was 6.5 years (5-8). RESULTS On average, the acetabular offset was reduced by 2.75mm±5.9 mm (range: -17.5 to +10.6 mm) (P<0.001) and the femoral offset was increased by 0.01mm±5.5 mm (range: -17.8 to +11.0 mm) (P=0.99). In terms of total offset, medialization of 2.74mm±7 mm (range: -17.7 to +18.2mm) was found (P=0.001). The acetabular center of rotation was on average 4.77mm±5.1 mm higher (P<0.001). The mean annual wear at the more recent follow-up (min.: 5 years) was 0.068mm (range: 0.01 to 0.25mm) per year. The wear was not impacted by having more than 5mm change in offset. DISCUSSION Measurements of acetabular offset revealed statistically significant medialization due to the type of implant used and the surgical technique. The anatomical technique consists of positioning the cup in subchondral bone without contacting the quadrilateral plate. This preserves bone stock, which may be useful later on if the cup is revised, particularly in younger patients. Conversely, the femoral offset did not change significantly, despite the use of lateralized stems in 92.0% of cases. We measured an annual wear rate of 0.068mm per year, which is lower than in other published studies, possibly because our patient population was older. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- R Erivan
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France.
| | - S Aubret
- Université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - G Villatte
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - A Mulliez
- Délégation à la recherche clinique et aux innovations (DRCI), CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - S Descamps
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - S Boisgard
- CNRS, SIGMA Clermont, ICCF, université Clermont Auvergne, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
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Ji HM, Won SH, Han J, Won YY. Does femoral offset recover and affect the functional outcome of patients with displaced femoral neck fracture following hemiarthroplasty? Injury 2017; 48:1170-1174. [PMID: 28365072 DOI: 10.1016/j.injury.2017.03.022] [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: 12/02/2016] [Revised: 03/16/2017] [Accepted: 03/20/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. METHODS One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. RESULTS The mean preoperative offset was 37.4±2.5 increased by 12.7±9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS (B=4.576; β=0.235; 95% confidence interval of B: 0.534 to 8.135). CONCLUSIONS FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture. FO restoration independently predicted fair MBI after the surgery. Therefore, surgeons should pay attention to restoring FO with meticulous templating.
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Affiliation(s)
| | - Seok-Hyung Won
- Department of Orthopaedics, Ajou University School of Medicine, Republic of Korea
| | - Jun Han
- Department of Orthopaedics, Ajou University School of Medicine, Republic of Korea
| | - Ye-Yeon Won
- Department of Orthopaedics, Ajou University School of Medicine, Republic of Korea.
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Ikeda T, Jinno T, Aizawa J, Masuda T, Hirakawa K, Ninomiya K, Suzuki K, Morita S. Effects of perioperative factors and hip geometry on hip abductor muscle strength during the first 6 months after anterolateral total hip arthroplasty. J Phys Ther Sci 2017; 29:295-300. [PMID: 28265161 PMCID: PMC5332992 DOI: 10.1589/jpts.29.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/07/2016] [Indexed: 12/16/2022] Open
Abstract
[Purpose] The importance and effect of hip joint geometry on hip abductor muscle strength
are well known. In addition, other perioperative factors are also known to affect hip
abductor muscle strength. This study examined the relative importance of factors affecting
hip abductor muscle strength after total hip arthroplasty. [Subjects and Methods] The
subjects were 97 females with osteoarthritis scheduled for primary unilateral THA. The
following variables were assessed preoperatively and 2 and 6 months after surgery:
isometric hip abductor strength, radiographic analysis (Crowe class, postoperative femoral
offset (FO)), Frenchay Activities Index, compliance rate with home exercise, Japanese
Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), and demographic data.
Factors related to isometric hip abductor muscle strength 2 and 6 months after surgery
were examined. [Results] Significant factors related to isometric hip abductor muscle
strength at 2 and 6 months after surgery were, in extraction order: 1. isometric hip
abductor muscle strength in the preoperative period; 2. BMI; and 3. the JHEQ mental score
at 2 and 6 months after surgery. [Conclusion] Preoperative factors and postoperative
mental status were related to postoperative isometric hip abductor strength. FO was not
extracted as a significant factor related to postoperative isomeric hip abductor
strength.
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Affiliation(s)
- Takashi Ikeda
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, Japan; Showa University School of Nursing and Rehabilitation Sciences, Japan
| | - Tetsuya Jinno
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University Graduate School, Japan
| | - Junya Aizawa
- Clinical Center for Sports Medicine & Sports Dentistry, Tokyo Medical and Dental University, Japan
| | - Tadashi Masuda
- Faculty of Symbiotic Systems Science, Fukushima University, Japan
| | | | | | - Kouji Suzuki
- Shonan Kamakura Joint Reconstruction Center, Japan
| | - Sadao Morita
- Department of Rehabilitation Medicine, Tokyo Medical and Dental University Graduate School, Japan
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Cementless lateralized stems in primary THA: Mid-term survival and risk factors for failure in 172 stems. Orthop Traumatol Surg Res 2017; 103:15-19. [PMID: 27914976 DOI: 10.1016/j.otsr.2016.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/27/2016] [Accepted: 10/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Increasing the femoral offset when performing total hip arthroplasty (THA) theoretically increases the stresses and risks of the stem not integrating itself into bone. But this concept has not been validated for cementless stems; this led us to conduct a retrospective study to determine: (1) the risk factors for the occurrence of symptomatic femoral radiological abnormalities, (2) the incidence of these abnormal radiological findings, (3) the revision rate for aseptic non-integration of a cementless lateralized stem. HYPOTHESIS Young patients with significant femoral canal flare and a small cementless lateralized stem have a higher risk of abnormal osseointegration. MATERIAL AND METHODS We analyzed retrospectively 172 consecutive lateralized stems (KHO, Corail™ product line) implanted during primary THA between 2006 and 2012 in 157 patients (mean age 68years±12.6 (20-95), 89% men). Radiographs were used to evaluate osseointegration scores, offset restoration and the Noble index. Kaplan-Meier survival analysis was performed using "symptomatic femoral radiological abnormalities" and "revision for aseptic stem non-integration" as endpoints. RESULTS The mean follow-up was 5.9years±2.7 (range, 2-12.4years). Being more than 70years of age (HR=0.7, 95% CI: [0.3-0.9], P=0.004) and having a larger stem (HR=0.6, 95% CI: [0.4-0.9], P=0.03) were protective against symptomatic femoral radiological abnormalities, while increasing the postoperative femoral offset (HR=1.1, 95% CI: [1.01-1.2], P=0.02) was deleterious. The survival free of "symptomatic femoral radiological abnormalities" was 93% (95% CI: 89-97) at 5years and 84% (95% CI: 75-95) at 8years. The survival free of "revision for aseptic stem non-integration" was 98% (95% CI: 96.8-100) at 5years and 97% (95% CI: 95.2-100) at 8years. DISCUSSION In this study, the risk factors for symptomatic radiological abnormalities were being less than 70years of age, having a small lateralized stem and restoring a large femoral offset. Lateralized stems used in this study had a 10% rate of symptomatic radiological abnormalities and a 4% rate of revision for aseptic non-integration. LEVEL OF EVIDENCE IV, retrospective study.
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