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Jud L, Rüedi N, Dimitriou D, Hoch A, Zingg PO. High femoral offset as a risk factor for aseptic femoral component loosening in cementless primary total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2024; 48:1217-1224. [PMID: 38388804 PMCID: PMC11001651 DOI: 10.1007/s00264-024-06116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Lateralized stems in primary cementless total hip arthroplasty (THA) showed to be associated with aseptic femoral loosening. However, femoral head length also affects femoral offset but was not considered so far. This study analyzed the impact of high femoral offset (hFO) combinations, formed by lateralized stems or large femoral head lengths, on aseptic femoral component loosening. METHODS Retrospective cohort study was performed including all patients that underwent primary cementless THA at our institution between July 2004 and December 2016. Patients were screened for aseptic femoral component loosening and grouped in aseptic loosening (AL) and non-aseptic loosening (nAL) group. Medical records were screened; implant details were noted and classified in hFO and standard femoral offset (sFO) combinations. Supposed risk factors for aseptic loosening were analyzed. RESULTS Two thousand four hundred fifty-nine THA could be included, containing 14 THA (0.6%) with aseptic femoral component loosening. The AL group contained 11 hFO combinations (78.6%), whereas in the nAL group, 1315 hFO combinations (53.8%) were used. Subgroup analysis showed significant difference between two groups for hFO combinations (p = 0.014), age (p = 0.002), NSAR (p = 0.001), and bilateral THA on same day (p = 0.001). The multiple logistic regression analysis showed that hFO combination was the only variable for increased probability of aseptic loosening (OR, 3.7; p = 0.04). CONCLUSION High femoral offset combinations, formed by lateralized stems or large femoral head lengths in our collective of standard straight stems implanted by an anterior approach, show a 3.7-fold increased probability for aseptic femoral component loosening. Adjustment of the postoperative protocol may be considered in these cases to ensure proper stem ingrowth.
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Affiliation(s)
- Lukas Jud
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Nico Rüedi
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Dimitris Dimitriou
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Armando Hoch
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Patrick O Zingg
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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Jiawei L, Kai Z, Haiyan W, Chao W, Yunfeng Z, Liangjia D, Qinghua L, Canran L, Feng J, Xiaohe L. Digital measurement and clinical significance of proximal femur in the older people of Inner Mongolia population, China. BMC Geriatr 2023; 23:632. [PMID: 37803256 PMCID: PMC10559419 DOI: 10.1186/s12877-023-04254-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 08/24/2023] [Indexed: 10/08/2023] Open
Abstract
OBJECTIVE This study aimed to measure the parameters of the proximal femur in the older people of Inner Mongolia, China and understand the influence of age and gender so as to provide guidance for the design and improvement of prosthesis for total hip arthroplasty. METHODS A total of 236 patients who underwent CT angiography of lower limbs in the Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University of China were collected. They were divided into 4 groups according to age: < 60 (group A), 60-69 (group B), 70-79 (group C), and > 80 years (group D). Four anatomical parameters, including femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO), femoral neck anteversion (FNA), were measured by Mimics 21.0. Comparisons were made between age groups of the same gender and between genders in the same age group to analyze the correlation of the 4 parameters of proximal femur with age and gender. In addition, the results of this study were compared with previous studies. RESULTS There were no significant differences in FHD and FO between age groups, indicating no correlation with age. FNSA and FNA were no significantly different between group C and group D in the same gender, whereas there were significant differences between other age groups and were negatively correlated with age. There were significant differences in FHD and FO between genders in the same age group, with the males being larger than the females. FNSA and FNA were no significant differences between genders in the same age group. CONCLUSIONS FNSA and FNA decrease with age. FHD and FO were larger in males than in females in all age groups. Age and gender should be considered in the design of prosthesis.
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Affiliation(s)
- Li Jiawei
- Department of Imaging, The Second Affiliated Hospital of Baotou Medical College, Baotou, 014030, Inner Mongolia Autonomous Region, China
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Kai
- Department of Orthopedics, The Second People's Hospital of Ulanqab, Ulanqab, 012000, Inner Mongolia Autonomous Region, China.
| | - Wang Haiyan
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Wu Chao
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Zhang Yunfeng
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Ding Liangjia
- Department of Imaging, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Liu Qinghua
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Canran
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Jin Feng
- Department of Imaging, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Li Xiaohe
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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Mellor FE, Smith L, England A, Snaith B, Cosson P. A retrospective evaluation of supine pelvic radiography image quality using centring points and anatomical axial rotation, including reliability of measurements (ARLEX-P STUDY). Radiography (Lond) 2023; 29:941-949. [PMID: 37531694 DOI: 10.1016/j.radi.2023.07.002] [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: 11/07/2022] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION Pelvic radiographs are commonly used for the investigation of a variety of conditions. Comparison between examinations requires a consistent radiographic technique but variations in image quality and radiographic centring points are frequently reported in the literature. The aim of this study was to establish the amount of variation in the radiographic centring point (RCP) and pelvic axial rotation (PAR), with a secondary aim of reporting the reliability of such measures. METHODS Using a previously acquired imaging archive, 633 adult pelvis/hip radiographs were identified on a Picture Archiving and Communication System (PACS). Radiographs with bilateral prostheses, evidence of acute pelvic trauma, projections acquired on a stretcher/trolley and those demonstrating large discontinuity between the detector and X-ray field centre were excluded. To determine centring point variation (+ values denote superior variations) and axial rotation multiple measurements were obtained from each radiograph. A video was used to train five observers and each of these reviewed ten random cases to determine inter- and intra-rater reliability. One of the five observers then performed the measurements on all remaining radiographs. RESULTS Following exclusions 380 radiographs were evaluated. The median (IQR) RCP deviation from the inter-acetabular line was +22 (+2 to +43) mm where both iliac crests were present and -29 (-45 to -12) mm where they were not. Eleven (3%) cases demonstrate RCP variation from the midline of greater than 25 mm (no bias towards the left or right side). The median (IQR) PAR was 0.0 (-1.5 to 1.4) degrees with greater variance in PAR for male participants (p = 0.004). Almost 60% of inter-rater ICC measurements were categorised as excellent, good or moderate. CONCLUSION Variations in RCP and PAR exist when evaluating a sample of routinely acquired pelvis radiographs. Some initial factors, such as sex and sub-examination type (full pelvis [XPEL] or low centred pelvis [XHIPB]) have been identified as having a statistical affect on variability. Further research and methods to standardise radiographic techniques is required and must be multidimensional in nature. IMPLICATIONS FOR PRACTICE Selection of radiographic technique, including RCP, appears to influence components of the pelvis radiograph. Given the increasing clinical requirements for pelvic radiography further standardisation alongside individual optimisation is warranted.
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Affiliation(s)
- F E Mellor
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | - L Smith
- United Lincolnshire NHS Trust, Lincoln, UK
| | - A England
- University College Cork, Cork, Ireland.
| | - B Snaith
- Radiology Department, Mid Yorkshire Hospitals NHS Trust, Pinderfields Hospital, Wakefield, UK; Faculty of Health Studies, University of Bradford, Bradford, UK
| | - P Cosson
- Teesside University, Middlesbrough, UK
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Faraj A, Andrews M, Li W. Inter and intra-observer errors for postoperative total hip radiographic assessment using computer aided design. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Plain radiographic assessment of primary total hip arthroplasty following surgery remains to be the commonest radiological assessment. The current paper, studies the accuracy and concordance between observers reviewing these radiographs.
A prospective radiographic and medical note review of ten patients who underwent total hip replacement for primary osteoarthritis, with a mean age of 69 years. Early and 6 weeks postoperative x-rays were assessed for hip profile and version profile using computer aided design (CAD) by two observers on two different occasions. The observers were Orthopaedic surgeons who perform arthroplasty of the hip. The results were analyzed statistically.
Dimensions, including Femoral offset, medial offset and ilioischial offset showed a high degree of inter- film and intra-film correlation, with inter-class correlation (ICC) over 0.8. Except of the intra-film correlation of ilioischial offset measured on the post- operative films (p=0.067) by the first rater, all the intra and inter film correlation were significantly over the benchmark of 0.6. In terms of stem alignment, cup inclination and cup version, the intra-film correlation by rater n°2 ranges from 0.574 to 0.975 and were significantly over the benchmark of 0.6, except in the case of cup inclination measured on the 6 th? week follow-up ; meanwhile the intra-film correlation by rater n°1 ranges from 0.581 to 0.819 and none were significantly over the benchmark of 0.6.
The inter-rater reliability and inter-film correlation showed a dichotomy of results among different dimensions of the measurement. Dimensions of femo- ral offset, medial offset and ilioischial offset showed a substantial degree of reliability in terms of inter-rater reliability, inter-film correlation, and intra-rater/film reliability.
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Floerkemeier T. Patientenspezifische Planung in der Hüftendoprothetik. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00461-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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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Buttaro MA, Oñativia JI, Slullitel PA, Andreoli M, Comba F, Zanotti G, Piccaluga F. Metaphyseal debonding of the Corail collarless cementless stem: report of 18 cases and case-control study. Bone Joint J 2017; 99-B:1435-1441. [PMID: 29092981 DOI: 10.1302/0301-620x.99b11.bjj-2017-0431.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 06/22/2017] [Indexed: 11/05/2022]
Abstract
AIMS The Corail stem has good long-term results. After four years of using this stem, we have detected a small group of patients who have presented with symptomatic metaphyseal debonding. The aim of this study was to quantify the incidence of this complication, to delineate the characteristics of patients presenting with this complication and to compare these patients with asymptomatic controls to determine any important predisposing factors. PATIENTS AND METHODS Of 855 Corail collarless cementless stems implanted for osteoarthritis, 18 presented with symptomatic metaphyseal debonding. A control group of 74 randomly selected patients was assembled. Clinical and radiological parameters were measured and a logistic regression model was created to evaluate factors associated with metaphyseal debonding. RESULTS The prevalence of this complication was 2.1% in our series. In the multivariable model, the presence of a Dorr B-type proximal femur was associated with metaphyseal debonding (odds ratio (OR) 10.73, 95% confidence interval (CI) 2.31 to 49.97, p = 0.002), as was a body mass index > 25 kg/m2 (OR 6.85, 95% CI 1.06 to 44.28, p = 0.04). Smaller stems and the use of a polyethylene acetabular liner appeared to be protective when compared with metal and ceramic setting hard-on-hard bearings. CONCLUSION We have described an uncommon but important mode of failure of the Corail stem. Surgeons should be aware of this phenomenon; overweight patients with Dorr B-type femurs and in whom hard bearings are used appear to be particularly at risk. Cite this article: Bone Joint J 2017;99-B:1435-41.
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Affiliation(s)
- M A Buttaro
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - J I Oñativia
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - P A Slullitel
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - M Andreoli
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Comba
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - G Zanotti
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - F Piccaluga
- Institute of Orthopaedics "Carlos E. Ottolenghi" Italian Hospital of Buenos Aires, Buenos Aires, Argentina
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De Fine M, Romagnoli M, Toscano A, Bondi A, Nanni M, Zaffagnini S. Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review. Orthop Traumatol Surg Res 2017; 103:349-355. [PMID: 28159679 DOI: 10.1016/j.otsr.2016.12.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/16/2016] [Accepted: 12/29/2016] [Indexed: 02/02/2023]
Abstract
UNLABELLED Benefits of femoral offset restoration during total hip arthroplasty should be the reduction of bearing surfaces wear, implant loosening and dislocation rates. Modular neck stems ensure offset customization but fretting corrosion and catastrophic failures are well-documented complications. Since clinical evidences are needed to substantiate the effectiveness of femoral offset restoration and promote modular neck choice, we systematically reviewed the literature to ascertain whether femoral offset itself has a proven clinical influence: (1) on bearing surfaces wear, (2) implant loosening, (3) and dislocation rates. A systematic literature screening was conducted to find papers dealing with the influence of femoral offset on wear, dislocation and loosening, including articles with conventional radiographic femoral offset assessment and with comparative design. Observational studies, case reports, instructional course lectures, cadaveric and animal studies as well as biomechanical studies, letters to the editor, surgical techniques or technical notes were all excluded. No limits about publication date were supplied but only papers in English were taken into account. Data were extracted into an anonymous spreadsheet. Offset values, dislocation rates, wear rates, follow-up and surgical approaches were all detailed. Ten manuscripts were finally selected. A statistically significant correlation between femoral offset restoration and the reduction of conventional ultrahigh-molecular-weight polyethylene wear was found in two out of three papers investigating this issue, but no correlations were found between femoral offset and dislocation rates or implant loosening. Femoral offset modification influences ultrahigh-molecular-weight polyethylene liners wear, but no correlation was found with dislocation rates or implant loosening. Advantages on wear can be counterbalanced by the use of hard bearing surfaces or highly cross-linked polyethylene liners, besides the availability of larger femoral heads improving implant stability further reduces the importance of femoral offset restoration by means of modularity. We believe that efforts in restoring femoral offset during total hip arthroplasty do not translate into tangible clinical profits and consequently, we do not advise the routinely usage of modular neck stems in total hip arthroplasty. LEVEL OF EVIDENCE level III, systematic review of case-control studies.
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Affiliation(s)
- M De Fine
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy.
| | - M Romagnoli
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - A Toscano
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - A Bondi
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - M Nanni
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
| | - S Zaffagnini
- General Orthopaedic Surgery, Rizzoli-Sicilia Department, Rizzoli Orthopaedic Institute, SS 113, km 246, 90011, Bagheria (PA), Italy
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Wang Q, Xiao J, Zhu L, Zhao X, Liu Z, Wang J, Qin Y. Acetate templating on calibrated standing digital radiograph improves accuracy of preoperative templating for total hip arthroplasty. Orthop Traumatol Surg Res 2017; 103:341-347. [PMID: 28263807 DOI: 10.1016/j.otsr.2016.12.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/27/2016] [Accepted: 12/29/2016] [Indexed: 02/09/2023]
Abstract
BACKGROUND The accuracy of preoperative templating with respect to leg length, femoral offset, and the size of femoral and acetabular components is essential to the success of total hip arthroplasty (THA). Traditionally, templating has been performed using printed film with acetate templates. However, preoperative templating designed by different prosthetic manufacturers cannot be used directly on the film due to varying acetate template amplification ratios. Computer-based templating needs specialized digital templating software, which has cost implications. To address these shortcomings, we bring forward several questions: (1) the accuracy of traditional manual templating combined with the calibrated digital radiograph for preoperative templating, (2) the inter- and intraobserver reliability of this method. HYPOTHESIS Using calibrated digital radiograph with traditional manual templating improves the accuracy and reproducibility of preoperative templating for THA. PATIENTS AND METHODS We designed a stepwise method that combines the traditional manual templating with standing digital radiograph calibrated by a scaling ball. Two separate observers (XJL, QYG) analyzed data of 82 patients (109 THAs) who had undergone THA with preoperative templating using the calibrated digital templating. The intra- and interobserver reliability was assessed by intraclass correlation coefficient. RESULTS The size of the acetate template acetabular based on our method was identical to the actual implanted acetabular size in 55.0% (XJL 110/218 [50.5%]; QYG 130/218 [59.6%]) of the cases indicating moderate accuracy. The intraclass correlation coefficient (ICC) for acetabular templating indicated almost perfect interobserver (ICC=0.918 [95% CI, 0.893-0.937]) and intraobserver agreement (ICC=0.932 [95% CI, 0.912-0.947]). While the exact implanted femoral size was predicted in 55.3% (XJL 122/218 [56.0%]; QYG 119/218 [54.6%]) of the cases. The ICC for femoral component templating indicated almost perfect interobserver (ICC=0.944 [95% CI, 0.927-0.957]) and intraobserver agreement (ICC=0.909 [95% CI, 0.883-0.930]). DISCUSSION This new stepwise method may prove to be a more reliable preoperative design choice to accurately calibrate magnification with radiograph, and could solve the incompatibility of the preoperative template designed by different prosthetic companies for direct use with the x-ray film. The method described is practical, convenient, cost-effective and does not require specialized equipment or software, thus making it particularly suitable for use in underdeveloped settings. LEVEL OF EVIDENCE Level IV, case series without controls.
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Affiliation(s)
- Q Wang
- Department of Orthopaedic Surgery, 2nd Hospital of Jilin University, 218#, Zi Qiang Street, Changchun, Jilin, 130041, China
| | - J Xiao
- Department of Orthopaedic Surgery, China-Japan Union Hospital of Jilin University, 126#, Xian Tai Street, Changchun, Jilin, 130033, China
| | - L Zhu
- Changchun University of Chinese Medicine, 1035#, Bo Shuo Street, Changchun, Jilin, 130000, China
| | - X Zhao
- Department of Orthopaedic Surgery, 2nd Hospital of Jilin University, 218#, Zi Qiang Street, Changchun, Jilin, 130041, China
| | - Z Liu
- Department of Orthopaedic Surgery, 2nd Hospital of Jilin University, 218#, Zi Qiang Street, Changchun, Jilin, 130041, China
| | - J Wang
- Department of Orthopaedic Surgery, 2nd Hospital of Jilin University, 218#, Zi Qiang Street, Changchun, Jilin, 130041, China
| | - Y Qin
- Department of Orthopaedic Surgery, 2nd Hospital of Jilin University, 218#, Zi Qiang Street, Changchun, Jilin, 130041, China.
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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: 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: 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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Amirouche F, Solitro G, Walia A. No effect of femoral offset on bone implant micromotion in an experimental model. Orthop Traumatol Surg Res 2016; 102:379-85. [PMID: 26970866 DOI: 10.1016/j.otsr.2016.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/15/2016] [Accepted: 01/19/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND In total hip replacement (THR), the femoral offset (FO) is assessed preoperatively, and the surgeon must determine whether to restore, increase, or decrease the FO based on experience and the patient's clinical history. The FO is known to influence the abductor muscle strength, range of motion (ROM), gait, and hip pain after THR; however, the true effect of FO on bone implant micromotion is unclear. Therefore, we investigated to assess: (1) the muscle loading response during gait, (2) whether FO affects bone implant micromotion during gait. HYPOTHESIS A variation of ±10mm from the anatomical FO affects the muscle loading forces. MATERIALS AND METHODS We modified a personalized musculoskeletal model of the lower extremity to determine the 3-dimensional contact forces at the hip joint in the presence of a stem with varying offsets during a gait cycle. A detailed finite element (FE) model was then constructed for increased, restored, and decreased FOs. The maximum load obtained during normal walking gait from the musculoskeletal model was applied to the respective FE models, and the resultant stem-bone micromotion and stress distribution were computed. RESULTS Increasing the FO to +10mm decreased the peak force generated by the abductor muscles during the cycle by 15.0% and decreasing the FO to -10mm increased the von Mises stress distribution at the distal bone by 77.5% (P<0.05). A variation of the offset within 10mm of the anatomical offset showed no significant differences in micromotion (P>0.05) and peak stresses (P>0.05). DISCUSSION Coupling the musculoskeletal model of the gait cycle with FE analysis provides a realistic model to understand how FO affects bone implant micromotion. We found that there was no effect of FO on bone implant micromotion; thus, a surgeon does not need to evaluate the implications of FO on micromotion and can determine a FO that best decreases the work load of abductor muscles, increases ROM, and reduces hip pain. LEVEL OF EVIDENCE IV, biomechanical study.
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Affiliation(s)
- F Amirouche
- University of Illinois at Chicago, Department of Orthopaedics, 835, S. Wolcott avenue, Room E270, Chicago, IL 60612, USA.
| | - G Solitro
- University of Illinois at Chicago, Department of Orthopaedics, 835, S. Wolcott avenue, Room E270, Chicago, IL 60612, USA
| | - A Walia
- University of Illinois at Chicago, Department of Orthopaedics, 835, S. Wolcott avenue, Room E270, Chicago, IL 60612, USA
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Flecher X, Ollivier M, Argenson JN. Lower limb length and offset in total hip arthroplasty. Orthop Traumatol Surg Res 2016; 102:S9-20. [PMID: 26797005 DOI: 10.1016/j.otsr.2015.11.001] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/11/2015] [Accepted: 11/06/2015] [Indexed: 02/02/2023]
Abstract
Restoration of normal hip biomechanics is a key goal of total hip arthroplasty (THA) and favorably affects functional recovery. Furthermore, a major concern for both the surgeon and the patient is preservation or restoration of limb length equality, which must be achieved without compromising the stability of the prosthesis. Here, definitions are given for anatomic and functional limb length discrepancies and for femoral and hip offset, determined taking anteversion into account. Data on the influence of operated-limb length and offset on patient satisfaction, hip function, and prosthesis survival after THA are reviewed. Errors may adversely impact function, quality of life, and prosthetic survival and may also generate conflicts between the surgeon and patient. Surgeons rely on two- or three-dimensional preoperative templating and on intraoperative landmarks to manage offset and length. Accuracy can be improved by using computer-assisted planning or surgery and the more recently introduced EOS imaging system. The prosthetic's armamentarium now includes varus-aligned and lateralized implants, as well as implants with modular or custom-made necks, which allow restoration of the normal hip geometry, most notably in patients with coxa vara or coxa valga. Femoral anteversion must also receive careful attention. The most common errors are limb lengthening and a decrease in hip offset. When symptoms are caused by an error in length and/or offset, revision arthroplasty may deserve consideration.
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Affiliation(s)
- X Flecher
- Service d'Orthopédie-Traumatologie, CHU Sud, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
| | - M Ollivier
- Service d'Orthopédie-Traumatologie, CHU Sud, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - J N Argenson
- Service d'Orthopédie-Traumatologie, CHU Sud, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
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Bjarnason JA, Reikeras O. Changes of center of rotation and femoral offset in total hip arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 3:355. [PMID: 26807410 DOI: 10.3978/j.issn.2305-5839.2015.12.37] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND It is a challenge to reconstruct the center of rotation (COR) and femoroacetabular offset anatomically in total hip arthroplasty (THA). We addressed the controversy how we manage to preserve the COR and femoroacetabular offset with an uncemented total hip prosthesis implanted with free hand technique. METHODS We analyzed a prospective series of 73 patients who underwent primary THA. The series was composed of 40 females and 33 males, mean age 64 years (range, 35-90 years). The reasons for THA were primary osteoarthritis (n=63) and developmental dysplasia of the hip (n=10). Pre- and postoperative X-rays were done in a standardized format for anterior-posterior (AP) radiographs of the pelvis, and digitalized measurements were done using SectraTM. We compared preoperative measurements with the final outcome to determine changes in COR and femoral offset. RESULTS We found that 40 patients had their COR and 34 patients had their femoral offset preserved within preoperative 5.0 mm limits. Twenty-three patients had both their values of COR and femoral offset preserved within 5.0 mm limits. While a significant correlation was found between changes of femoral and global offset (r=0.786, P<0.001), there were no correlation between changes of acetabular and femoral offset (r=-0.027, P=0.822). CONCLUSIONS Using an uncemented THA and free hand technique, there is a fair reproducibility of anatomy. The variations were mostly minor, but our results indicate a potential for better restoring the location of COR and femoral offset when planning and implanting an uncemented THA.
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Affiliation(s)
- Jon A Bjarnason
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
| | - Olav Reikeras
- Department of Orthopedics, Rikshospitalet, Oslo University Hospital, N-0027 Oslo, Norway
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The femoral neck-shaft angle on plain radiographs: a systematic review. Skeletal Radiol 2016; 45:19-28. [PMID: 26305058 DOI: 10.1007/s00256-015-2236-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 07/12/2015] [Accepted: 08/11/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The femoral neck-shaft angle (NSA) is an important measure for the assessment of the anatomy of the hip and planning of operations. Despite its common use, there remains disagreement concerning the method of measurement and the correction of hip rotation and femoral version of the projected NSA on conventional radiographs. We addressed the following questions: (1) What are the reported values for NSA in normal adult subjects and in osteoarthritis? (2) Is there a difference between non-corrected and rotation-corrected measurements? (3) Which methods are used for measuring the NSA on plain radiographs? (4) What could be learned from an analysis of the intra- and interobserver reliability? MATERIAL AND METHODS A systematic literature search was performed including 26 publications reporting the measurement of the NSA on conventional radiographs. RESULTS The mean NSA of healthy adults (5,089 hips) was 128.8° (98-180°) and 131.5° (115-155°) in patients with osteoarthritis (1230 hips). The mean NSA was 128.5° (127-130.5°) for the rotation-corrected and 129.5° (119.6-151°) for the non-corrected measurements. CONCLUSION Our data showed a high variance of the reported neck-shaft angles. Notably, we identified the inconsistency of the published methods of measurement as a central issue. The reported effect of rotation-correction cannot be reliably verified.
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Cantin O, Viste A, Desmarchelier R, Besse JL, Fessy MH. Compared fixation and survival of 280 lateralised vs 527 standard cementless stems after two years (1-7). Orthop Traumatol Surg Res 2015; 101:775-80. [PMID: 26476972 DOI: 10.1016/j.otsr.2015.08.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/04/2015] [Accepted: 08/26/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Restoring the native hip anatomy increases hip prosthesis survival, whereas increased femoral lateralisation creates high torque stresses that may alter prosthesis fixation. After finding lucent lines around cementless lateralised stems (Corail™, DePuy Synthes, St Priest, France) in several patients, we evaluated the effects of lateralisation in a large case-series. The objective of our study was to compare lateralised vs standard stems of identical design in terms of radiological osteo-integration and survival. HYPOTHESIS Lateralised stems, despite being used only when indicated by the anatomical parameters, carry a higher risk of impaired osteo-integration. MATERIALS AND METHODS A retrospective study was conducted in 807 primary total hip arthroplasties (THAs) performed between 2006 and 2010 in 798 patients with a mean age of 65 ± 14.2 years. Lateralised stems were used in 280 cases (Corail High Offset KHO, n = 169; and Corail coxa vara KLA, n = 111 cases) and standard stems in 527 cases (Corail KA). Mean follow-up was 2.3 years (range, 1-7 years). The clinical evaluation included determination of the Postel-Merle d'Aubigné (PMA) score. Bone fixation and stability of the implants were assessed by determining the Engh and Massin score and the ARA score on the radiographs at last follow-up. Femoral, acetabular and global offset values were determined before and after THA. Nobles's Canal Flare Index was computed. Survival was estimated using the Kaplan-Meier method with surgical revision for aseptic loosening as the end-point. RESULTS The PMA score improved from 12 (10-15) pre-operatively to 17.7 (14-18) (P < 0.05). After THA, in the lateralised stem group, femoral offset was restored in 217 (77%) hips and the mean change vs the pre-operative offset value was -2 mm; in the standard stem group, femoral offset was restored in 440 (83.5%) hips and the mean change was +1 mm. The Engh and Massin score values were similar in the standard stem and lateralised stem groups (24.4 ± 2.2 and 22.6 ± 2.4, respectively, NS). Revision for aseptic loosening was required in 5 patients with lateralised stems (3 KHO and 2 KLA) versus none of the patients with standard stems. There were no cases of excessive femoral offset and the mean change in offset was -2.3mm (-5.3 to -1.1). Noble's index was increased (4.27 ± 0.5 for the loosened lateralised stems, 3.65 ± 0.8 for the well-fixed lateralised stems and 3.82 ± 0.6 for the standard stems), with no significant difference across groups. Overall survival after 3.5 years of follow-up was 94.6% (95% confidence interval, 88.4-100%) with lateralised stems and 100% with standard stems (P < 0.05). DISCUSSION The risk of aseptic loosening was significantly higher with the lateralised stem (5/280, 1.8%) than with the standard stem (n = 0). Our findings indicate a need for careful preparation to obtain primary fixation of lateralised stems. LEVEL OF EVIDENCE III, retrospective case-control study.
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Affiliation(s)
- O Cantin
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France
| | - A Viste
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, Lyon, France; IFSTTAR, UMRT_9406, laboratoire de biomecanique et mécanique des chocs, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France.
| | - R Desmarchelier
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France
| | - J-L Besse
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, Lyon, France; IFSTTAR, UMRT_9406, laboratoire de biomecanique et mécanique des chocs, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - M H Fessy
- Service de chirurgie orthopédique et traumatologique, hospices Civils de Lyon, centre hospitalier Lyon-Sud, 165, chemin du Grand Revoyet, 69495 Pierre-Bénite cedex, France; Université de Lyon, Lyon, France; IFSTTAR, UMRT_9406, laboratoire de biomecanique et mécanique des chocs, 69500 Bron, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
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Arnould A, Boureau F, Benad K, Pasquier G, Migaud H, Girard J. Computed tomography evaluation of hip geometry restoration after total hip resurfacing. Orthop Traumatol Surg Res 2015; 101:571-5. [PMID: 26148967 DOI: 10.1016/j.otsr.2015.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anatomic reconstruction of the hip is among the main requirements for hip arthroplasty to be successful. Resurfacing arthroplasty may improve replication of the native joint geometry but has been evaluated only using standard radiographs. We therefore performed a computed tomography (CT) study to assess restoration of hip geometry after total hip resurfacing (HR), comparatively with the non-operated side. HYPOTHESIS HR does not change native extra-medullary hip geometry by more than 5mm and/or 5°. PATIENTS AND METHODS CT was used to evaluate unilateral HR in 75 patients with a mean age of 52.2years (range, 22-67years). The normal non-operated side served as the control in each patient. Mean follow-up was 2.5years (range, 1.9-3.1years). The primary evaluation criteria were femoral offset (FO) and femoral neck anteversion (FNA) and the secondary criteria were cup inclination angle, cup anteversion angle, and lower-limb length. RESULTS FO showed a non-significant decrease (mean, -2.2mm; range, -4.5 to +3.7mm). FNA was preserved, with a difference of less than 2° at last follow-up versus the preoperative value. Cup measurements showed a mean anteversion angle of 24.8° (0.9-48.6) and mean inclination angle of 44.1° (32.1-56.3); corresponding values for the native acetabulum were 38.9° (20.5-54.8) and 24.8° (4.8-33.6). The residual lower-limb length discrepancy was less than 1mm (mean, -0.04mm [-1.2 to +1.6mm]). The mean angle between the femoral implant and the femoral neck axis was 5.4° of valgus. DISCUSSION Our results show that HR accurately restored the native extra-medullary hip geometry. LEVEL OF EVIDENCE III, prospective diagnostic case-control study.
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Affiliation(s)
- A Arnould
- Service orthopédie D, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France.
| | - F Boureau
- Service orthopédie D, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France
| | - K Benad
- Service orthopédie D, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France
| | - G Pasquier
- Service orthopédie D, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Université Lille-Nord de France, 59000 Lille, France
| | - H Migaud
- Université Lille-Nord de France, 59000 Lille, France; Service orthopédie C, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France
| | - J Girard
- Université Lille-Nord de France, 59000 Lille, France; Service orthopédie C, centre hospitalier régional universitaire de Lille, 2, avenue Oscar-Lambret, 59037 Lille cedex, France; Domaine médecine et sport, faculté de médecine de Lille 2, 59037 Lille cedex, France
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Ollivier M, Parratte S, Galland A, Lunebourg A, Flecher X, Argenson JN. Titanium-titanium modular neck for primary THA. Result of a prospective series of 170 cemented THA with a minimum follow-up of 5 years. Orthop Traumatol Surg Res 2015; 101:137-42. [PMID: 25698098 DOI: 10.1016/j.otsr.2014.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although they have been in use since the end of the 1980s, modular titanium neck components are associated with a risk of wear or fracture, and their safety has recently become a subject of debate and has never been evaluated in a consecutive series of patients. The goal of this study was to evaluate: revision-free survival of these implants after a minimum follow-up of 5 years; clinical and radiographic results; and the potential complications associated with the use of modular titanium neck components. HYPOTHESIS The use of titanium modular neck on cemented titanium THA is safe at a minimum follow-up of 5 years. PATIENTS AND METHODS Between January 2006 and December 2008, we prospectively followed 170 patients (170 hips) who underwent primary anatomical THA with a modular cemented titanium stem design implant. The indications were unilateral THA for primary (n=160) or secondary (n=10) hip osteoarthritis (aseptic osteonecrosis of the femoral head or hip dysplasia). Mean age of patients was 75.4±5.8 years old (52-85), and mean BMI was 26.1±4.5 kg/m(2) (16.6-42.1). Patients were operated on by a modified Watson-Jones anterolateral approach based on preoperative 2D planning. All patients underwent annual clinical and radiological follow-up by an independent observer. RESULTS At a mean follow-up of 71±8 months (60-84), 5 patients died and 7 were lost to follow-up. There was no revision of THA after a maximum follow-up of 84 months. The Harris score improved significantly from 50.4±11.3 (0-76) preoperatively to 84.5±15.2 (14-100) at the final follow-up. There was no difference in postoperative femoral offset or the position of the center of rotation compared to the opposite side. On the other hand, the neck-shaft angle (NSA) and limb length were corrected (2±5° [-11 to +14°] and 2.16±3.6 mm [-7.4 to +12.7 mm]) respectively. Fifteen patients (9%) had limb length discrepancies of more than 5 mm and 4 patients (2%) of more than 10 mm. There were no complications due to the modular implant design. DISCUSSION Our study suggests that the use of cemented titanium implants with a modular titanium stem is safe at a follow-up of 5 years. The modular design does not prevent limb length discrepancies but restores femoral offset. LEVEL OF EVIDENCE IV: prospective, non-comparative study.
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Affiliation(s)
- M Ollivier
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - S Parratte
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - A Galland
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - A Lunebourg
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - X Flecher
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - J-N Argenson
- Institut du mouvement et de l'appareil locomoteur, UMR CNRS 787/AMU, hôpital Sainte-Marguerite, centre hospitalo-universitaire Sud, boulevard de Sainte-Marguerite, 13009 Marseille, France
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Ollivier M, Parratte S, Lecoz L, Flecher X, Argenson JN. Relation between lower extremity alignment and proximal femur anatomy. Parameters during total hip arthroplasty. Orthop Traumatol Surg Res 2013; 99:493-500. [PMID: 23806349 DOI: 10.1016/j.otsr.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 01/29/2013] [Accepted: 02/14/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lower extremity alignment correlates with native femoral offset. Eventual impact of the change in femoral offset induced by total hip arthroplasty (THA) on lower extremity alignment has not been documented. HYPOTHESIS THA significantly changes lower extremity alignment, and the change correlates with the change in femoral offset. MATERIALS AND METHODS We conducted a prospective study of 200 patients with primary hip osteoarthritis or avascular femoral head necrosis who underwent cementless THA. Pre-operative computed-tomography templating was performed and the femoral component was then custom-manufactured to replicate the native femoral anatomy. Mean age was 58 years (range, 28-83 years). Before and at least two years after THA, two observers who were not involved in the surgical procedures used standing antero-posterior long-leg radiographs to determine the mechanical axis of the lower-limb (hip-knee-ankle [HKA] angle), femoral offset, neck-shaft angle (NSA), and lower-limb length discrepancy (LLLD). RESULTS Mean values pre-operatively and at last follow-up were as follows: HKA angle, 179.2° ± 3.9° (range, 170.5° to 190.5°) and 177.7° ± 3.5°(range, 173° to 187°); LLLD, -0.7 mm (range, -30 mm to +25 mm) and +5.1 mm (range, -7 mm to +21 mm); NSA, 134° ± 7.5° (range, 100° to 124°) and 135° ± 4.2° (range, 124° to 146°); and femoral offset, 42 ± 7.8 mm (range, 24 mm to 68 mm) and 49 ± 7.5 mm (range, 33 mm to 70 mm). Although THA significantly altered lower-limb alignment, univariate and multivariate analyses showed no significant association between the change in HKA angle and the change in femoral offset. DISCUSSION Lower-limb alignment was significantly affected by THA, although the HKA angle changes were small. The small impact of THA on HKA angle values may be ascribable to efforts aimed at replicating the native femoral offset during arthroplasty, as well as to the limited sample size and to potential measurement errors related to the small size of the changes. Our results suggest that, provided careful attention is directed to replicating the native femoral offset, THA in patients with limited pre-operative anatomical abnormalities may have no major impact on the biomechanical parameters of the ipsilateral knee. LEVEL OF EVIDENCE Level III, prospective diagnostic study.
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Affiliation(s)
- M Ollivier
- Motion research and musculo-skeletal institute, Southern Teaching Hospital Center, Sainte-Marguerite Hospital, 270, boulevard Sainte-Marguerite, 13009 Marseille, France
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Piriou P, Bugyan H, Casalonga D, Lizée E, Trojani C, Versier G. Can hip anatomy be reconstructed with femoral components having only one neck morphology? A study on 466 hips. J Arthroplasty 2013; 28:1185-91. [PMID: 23245588 DOI: 10.1016/j.arth.2012.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Revised: 08/03/2012] [Accepted: 08/17/2012] [Indexed: 02/01/2023] Open
Abstract
This extensive radiographic study asks if there is a statistical relationship between the size of the stem that will best fit the femur and the vertical and lateral offsets of the reconstructed acetabular center, what is the distribution of vertical and lateral offsets in this large and if there is a statistical difference among surgeons in the planned location of the reconstructed acetabular center. On 466 radiographs, five surgeons separately templated stem size and acetabular cup location. The vertical and horizontal coordinates of the reconstructed acetabulum center were measured relative to the planned position of the stem. We found a strong correlation between the stem size and the average lateral and vertical offsets. Acetabular reaming associated with the anatomic variability of native femoral necks, leads to a span of 36 mm in lateral offset, and a span of 39 mm in vertical offset. Statistically significant differences were also found in the way surgeons plan acetabular reaming.
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Barbier O, Ollat D, Versier G. Interest of an intraoperative limb-length and offset measurement device in total hip arthroplasty. Orthop Traumatol Surg Res 2012; 98:398-404. [PMID: 22560790 DOI: 10.1016/j.otsr.2012.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/23/2012] [Accepted: 02/21/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) seeks to restore a stable, mobile and pain-free joint. This requires good implant positioning and peroperative restoration of limb-length and femoral offset. HYPOTHESIS A mechanical measurement device (length and offset optimization device [LOOD]) fixed to the pelvis can optimize lower-limb length and offset control during THA performed on a posterolateral approach. PATIENTS AND METHODS Two prospective THA series were compared: 32 using the LOOD and 26 without. Patients with more than 5mm preoperative limb-length discrepancy were excluded. The intraoperative target was to restore individual anatomy. Radiographic analysis was based on pre- and postoperative AP pelvic weight-bearing views in upright posture, feet aligned, with comparison to peroperative LOOD data. RESULTS Mean deviation from target length (i.e., pre- to postoperative length differential) was 2.31 mm (range, 0.04-10.6mm) in patients operated on using the LOOD versus 6.96 mm (0.01-178 mm) without LOOD (P=0.0013). Mean deviation from target offset was 3.96 (0.45-13.50) mm with LOOD versus 10.16 (0.93-28.81) without (P=0.0199). There was no significant difference between operative and radiographic measurements of length deviation using LOOD (P=0.4); those for offset, however, differed significantly (P=0.02). DISCUSSION The LOOD guides control of limb-length and offset during THA on a posterolateral approach. Reliability seems to be better for limb-length than for offset. It is a simple and undemanding means of controlling limb-length and offset during THA. LEVEL OF EVIDENCE III, prospective case-control study.
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Affiliation(s)
- O Barbier
- Bégin Military Teaching Hospital, 69, avenue de Paris, 94160 Paris, France.
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[Templating and radiological outcome monitoring for elective total hip arthroplasty. Applied quality management principles for safe patient care]. Unfallchirurg 2012; 114:776-85. [PMID: 21870133 DOI: 10.1007/s00113-011-2029-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Implementation of total hip arthroplasty is a successful and reliable treatment for end-stage osteoarthritis. The biomechanics and components as well as the fixation were selected with the aid of templating. Based on a cohort of 114 patients the quality of digital X-rays and the operative results were determined. There was a slight leg lengthening and a good offset reconstruction in these patients. For the patients with replacement of the second hip the leg lengthening was smaller. The cup inclination was at 43° and 44° within the desired range. The prediction of the exact component size used was 40% for the cup and 29% for the stem.Through variation in scaling of the digital X-ray a diminishing prediction accuracy was found in our study. The correction of biomechanics and position of components showed good quality in patient care. Templating and assessment of the postoperative result in total hip arthroplasty is a model for continuous quality management and can be recommended for safe patient care.
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