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Okamoto M, Seki T, Takegami Y, Osawa Y, Imagama S. Effect of trochanter displacement on impingement and bone contact in total hip arthroplasty performed after curved intertrochanteric varus osteotomy for osteonecrosis of the femoral head: a simulation study. BMC Musculoskelet Disord 2022; 23:850. [PMID: 36076229 PMCID: PMC9454145 DOI: 10.1186/s12891-022-05803-x] [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: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Curved intertrochanteric varus osteotomy (CVO) is a useful treatment option for osteonecrosis of the femoral head (ONFH). However, the effect of proximal femoral deformity in cases of CVO converted to total hip arthroplasty (THA) remains unclear. The aim of this study was to evaluate the effect of trochanter displacement on impingement and the contact state of the implant and femur in THA. Methods Thirty-eight hips that had undergone CVO for ONFH were reviewed and compared with a control group of 30 contralateral hips that had not undergone surgery. The range of motion (ROM) and impingement patterns and the percentage of cortical bone in the stem placement within the femur were measured by simulation using CT-based three-dimensional template software. We also measured the ROM and the number of joints that achieved the ROM required for activities of daily living when the upward displaced apex of the greater trochanter with osteotomy was resected and compared the findings with those obtained when the apex was not resected. Results The CVO group showed a significantly greater bony impingement in external rotation (68.4% vs. 43.3%, p = 0.033) and abduction (78.9% vs. 33.3%, p < 0.001) than in the control group. The CVO group showed a significantly smaller range of external rotation (19.0° [interquartile range; 4.0–28.8] vs. 38.0° [interquartile range; 36.0–41.8], p < 0.001) and abduction (23.0° [interquartile range; 8.5–38.8] vs. 56.0° [interquartile range; 50.3–60.0], p < 0.001) than in the control group. Significantly more joints achieved the ROM necessary for activities of daily living when the apex was resected than when it was not (10.5% vs. 63.2%, p < 0.001). The percentage of cortical bone in the stem placement position was significantly higher in the CVO group than in the control group in the proximal portion of the stem (25.5% vs. 0.0%, p < 0.001). Conclusion In cases requiring conversion to THA, we recommend resecting the upward displaced apex to achieve a sufficient ROM and carefully resecting the bone to avoid malignment of the stem.
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Affiliation(s)
- Masanori Okamoto
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Taisuke Seki
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yusuke Osawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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Shoji T, Saka H, Inoue T, Kato Y, Fujiwara Y, Yamasaki T, Yasunaga Y, Adachi N. Three-dimensional analysis of the cortical contact state of short and conventional stems in different stem positions in total hip arthroplasty. Clin Biomech (Bristol, Avon) 2021; 83:105297. [PMID: 33640706 DOI: 10.1016/j.clinbiomech.2021.105297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 02/09/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the increasing use of short cementless stems in total hip arthroplasty, their potential benefits have yet to be confirmed. We evaluated the cortical contact state of short and conventional stems in different femoral canal types and stem positions using a CT-based 3-dimensional templating software. METHODS We reviewed 153 hips in 153 patients, grouped according to femoral canal type-normal (68), champagne-flute (41), and stove-pipe canal (44). We investigated the influence of stem position on the contact state by evaluating three situations of stem anteversion (original anteversion, +5°anteverted, and +5°retroverted), three stem positions, neutral +2°extended, and +2°flexed positions using Taperloc Complete MicroplastyⓇ stem. FINDINGS The contact values of all zones between both stems in all canal types exhibited no significant differences. The values in zones 1, 2, 6, and 7 of both stems in 5° retroverted and anteverted, 2° extended and flexed positions were not significantly different compared to those of the neutral position. However, the values in zones 3, 4, and 5 of both stems were significantly greater compared to those of the neutral position in 2° extended and flexed positions; these values were also significantly larger in all canal types for the conventional stem. INTERPRETATION We demonstrated that the short and conventional stems can achieve the same proximal cortical contact in any femoral canal, regardless of the stem position. However, extended and flexed stem positions increase the distal contact, especially in conventional stems. Furthermore, the distal contact increases for the retroverted stem insertions.
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Affiliation(s)
- Takeshi Shoji
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | - Hideki Saka
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Tadashi Inoue
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuichi Kato
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yusuke Fujiwara
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Takuma Yamasaki
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yuji Yasunaga
- Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, 295-3 Taguchi, Saijo-town, Higashi-hiroshima 739-0036, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
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Yoshitani J, Kabata T, Kajino Y, Ohmori T, Ueno T, Ueoka K, Tsuchiya H. The use of density mapping in the analysis of thigh pain after total hip arthroplasty in patients with well-fixed tapered wedge stems. J Orthop Surg (Hong Kong) 2021; 28:2309499020930306. [PMID: 32529916 DOI: 10.1177/2309499020930306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The mechanisms underlying thigh pain in patients with well-fixed cementless femoral components after total hip arthroplasty (THA) remains unclear. We hypothesized that the thigh pain is correlated with the initial contact state of the stem and aimed to investigate the relation between thigh pain and the initial contact state. MATERIALS AND METHODS A total of 209 hips of 184 patients were analysed in this retrospective case-control study. The patients were divided into a thigh pain group (n = 13 hips) and a control group (without thigh pain, n = 196). Post-operative stem contact images were three-dimensionally visualized by a density mapping function using computed tomography data, which quantified the stem contact area according to Gruen zones. Thigh pain was defined as anterior or anterolateral pain upon loading at 3-month post-operatively. RESULTS Thirteen hips (6.2%) had thigh pain; however, all the hips demonstrated stable bony ingrowth radiographically. The thigh pain group had a significantly lower contact area in zone 2 (p = 0.014). The multivariate logistic regression analysis showed that the contact area of zone 2 was negatively correlated with thigh pain [odds ratio (OR): 0.858, p = 0.018], and the canal flare index was negatively correlated with the development of thigh pain (OR: 0.336, p = 0.026). CONCLUSIONS We identified an association between the initial contact state and post-operative thigh pain. Our data demonstrated that proper lateral contact prevents the occurrence of thigh pain in THA using a tapered wedge stem.
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Affiliation(s)
- Junya Yoshitani
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Tamon Kabata
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Yoshitomo Kajino
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takaaki Ohmori
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Takuro Ueno
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Ken Ueoka
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan
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Xu M, Motomura G, Ikemura S, Yamaguchi R, Utsunomiya T, Baba S, Kawano K, Nakashima Y. Proximal femoral morphology after transtrochanteric posterior rotational osteotomy for osteonecrosis of the femoral head: A three-dimensional simulation study. Orthop Traumatol Surg Res 2020; 106:1569-1574. [PMID: 33153958 DOI: 10.1016/j.otsr.2020.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Transtrochanteric posterior rotational osteotomy (PRO) is one of the joint-preserving surgeries for osteonecrosis of the femoral head. In general, postoperative femoral neck-shaft varus realignment is planned to obtain a sufficient intact articular surface of the femoral head in the weight-bearing portion. Unlike anterior rotational osteotomy, PRO allows for more than 90° rotation of the femoral head, resulting in more complicated morphology. However, little is known about the potential risk of postoperative femoral retroversion after PRO. This simulation study aims: 1) to assess whether postoperative femoral neck-shaft varus realignment can coexist with preserved femoral anteversion after PRO, 2) and whether postoperative proximal femoral morphology could be predicted with approximation equations. HYPOTHESIS High degree (>90°) PRO is favourable for femoral neck-shaft varus realignment, but unfavourable for maintaining postoperative femoral anteversion. MATERIALS AND METHODS PRO was simulated by using CT data from 10 hips in 10 healthy volunteers. During simulation, the intertrochanteric osteotomy plane was determined three-dimensionally based on anteroposterior-view line (the osteotomy line on anteroposterior view) and lateral-view line (the osteotomy line on lateral view). By changing either the angle of anteroposterior-view line or lateral-view line, we simulated 90°, 110°, 130° and 150° PRO. To clarify the effects of various posterior rotation angles on postoperative proximal femoral morphology, we made simplified PRO models through changing only the posterior rotation angle. RESULTS In the 90°, 110°, 130° and 150° PRO models, the vertically inclined angle of anteroposterior-view line showed a significant positive correlation with femoral neck-shaft varus realignment (90° PRO, r=0.90; 110° PRO, r=0.95; 130° PRO, r=0.97; 150° PRO, r=0.99), while a significant negative correlation with postoperative femoral anteversion angle (90° PRO, r=-0.97; 110° PRO, r=-0.95; 130° PRO, r=-0.92; 150° PRO, r=-0.7). Likewise, the posteriorly tilted angle of lateral-view line showed a significant negative correlation with both femoral neck-shaft varus realignment (90° PRO, r=-0.81; 110° PRO, r=-0.81; 130° PRO, r=-0.79; 150° PRO, r=-0.72) and postoperative femoral anteversion angle (90° PRO, r=-0.90; 110° PRO, r=-0.89; 130° PRO, r=-0.92; 150° PRO, r=-0.88). In the simplified PRO models, the posterior rotation angle showed a significant positive correlation with femoral neck-shaft varus realignment (r=0.33), while a significant negative correlation with postoperative femoral anteversion angle (r=-0.76). The approximation equations for predicting the proximal femoral morphology after PRO were validated. DISCUSSIONS It was confirmed that high-degree PRO (>90°) is favourable for femoral neck-shaft varus realignment, but works against preserving femoral anteversion. With the approximation equations developed in the current study, surgeons could examine the feasibility of PRO based on postoperative femoral anteversion. In terms of hip joint function and subsequent total hip arthroplasty, excessive deformities including femoral retroversion and severe varus deformity could be avoided. LEVEL OF EVIDENCE IV; case series without control group.
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Affiliation(s)
- Mingjian Xu
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Goro Motomura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan.
| | - Satoshi Ikemura
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Ryosuke Yamaguchi
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Takeshi Utsunomiya
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Shoji Baba
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Koichiro Kawano
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
| | - Yasuharu Nakashima
- Department of orthopaedic surgery, Graduate school of medical sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, 812-8582 Fukuoka, Japan
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