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Jacquot L, Machenaud A, Grew B, Ramos-Pascual S, Dubreuil S, Saffarini M, Chouteau J. No differences in clinical and radiographic outcomes between standard versus high offset collared stems for primary total hip arthroplasty at five years follow-up. INTERNATIONAL ORTHOPAEDICS 2024; 48:2525-2533. [PMID: 39112838 DOI: 10.1007/s00264-024-06264-8] [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: 07/12/2024] [Accepted: 07/24/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE To compare clinical and radiographic outcomes of propensity-matched patients undergoing THA using standard versus high offset stems at five years. METHODS The authors retrospectively reviewed a consecutive series of primary THAs performed between 01/09/2015-31/12/2017 using a fully-hydroxyapatite coated collared stem, with either a standard (n = 365) or high (n = 110) offset. Outcomes collected included: modified Harris Hip Score (mHHS), Oxford Hip Score (OHS), Forgotten Joint Score (FJS), and radiographic measurements including limb length discrepancy (LLD), stem subsidence, and stem radiolucencies. RESULTS Propensity score matching resulted in 80 hips per group. Preoperatively there were no significant differences in patient demographics, surgical data and radiographic measurements, except the standard offset group had significantly smaller femoral (40.0 ± 7.5 vs 48.4 ± 6.2, p < 0.001), acetabular (92. ± 6.3 vs 94.8 ± 7.3, p = 0.011) and global (132.0 ± 10.3 vs 143.2 ± 8.2, p < 0.001) offsets compared to the high offset group. At a minimum five years follow-up, there were no significant differences in mHHS (93.2 ± 11.0 vs 93.1 ± 10.6, p = 0.553), OHS (45.1 ± 4.1 vs 45.3 ± 4.6, p = 0.623), and FJS (85.1 ± 19.3 vs 82.7 ± 23.0, p = 0.910). There were also no differences in radiographic measurements, including LLD (1.5 ± 4.8 vs 1.1 ± 3.5, p = 0.537), stem subsidence (0% vs 0%, p = 1.000), and stem radiolucencies (severe: 6% vs 1%, p = 0.152). CONCLUSION The present matched-cohort study found no significant differences between standard versus high offset straight fully-hydroxyapatite coated collared stems for primary THA in terms of clinical and radiographic outcomes at five years. These findings may suggest that uncemented collared high offset stems are not associated with an increased risk of radiolucencies and loosening compared to uncemented collared standard offset stems.
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Affiliation(s)
- Laurent Jacquot
- Artro Institute, 8, Rue du Pont de Thé, 74940, Annecy Le Vieux, France
- Clinique d'Argonay, Centre Le Périclès, Allée de La Mandallaz 74370, Annecy, France
| | - Alain Machenaud
- Artro Institute, 8, Rue du Pont de Thé, 74940, Annecy Le Vieux, France
| | - Bethany Grew
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | | | | | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland
| | - Julien Chouteau
- Artro Institute, 8, Rue du Pont de Thé, 74940, Annecy Le Vieux, France
- Clinique d'Argonay, Centre Le Périclès, Allée de La Mandallaz 74370, Annecy, France
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D'Ambrosio A, Bonnomet F, Debordes PA, Ramos-Pascual S, Kumble A, Saffarini M, Ehlinger M, Favreau H. No differences in clinical and radiographic outcomes between standard offset and high offset short cementless stems. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05431-1. [PMID: 39168958 DOI: 10.1007/s00402-024-05431-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 06/27/2024] [Indexed: 08/23/2024]
Abstract
PURPOSE To compare clinical and radiographic outcomes of total hip arthroplasty (THA) using standard offset versus high offset short cementless stems. METHODS We reviewed a consecutive series of 204 primary THAs performed over 5 years using a short cementless collared stem. At a minimum follow-up of 2 years, 6 patients had deceased, 6 were not evaluated radiographically and, 2 were lost to follow-up. This left a final cohort of 190 hips, of which 72 had received a standard offset stem and 118 had received a high offset stem. Outcomes collected included: Oxford hip score (OHS), forgotten joint score (FJS), canal fill ratio (CFR), canal-bone ratio (CBR), stem subsidence (≥ 3 mm), stem misalignment (> 5°), radiolucent lines (≥ 2 mm), cortical hypertrophy, and calcar modifications. RESULTS There were no significant differences in postoperative clinical and radiographic outcomes between the standard offset and high offset groups, except for incidence of stems in varus (6% vs 17%; p = 0.001). Multivariable analyses revealed that OHS was significantly worse for patients of greater age (β = 0.1; p = 0.001), higher BMI (β = 0.2; p = 0.018), or with inflammatory arthropathy (β = 4.7; p = 0.005); while FJS was significantly worse for patients with higher BMI (β = - 0.7; p = 0.003); and cortical hypertrophy was significantly associated with CBR (OR > 100; p = 0.008). CONCLUSIONS There were little to no differences in clinical or radiographic outcomes of THA performed using standard offset versus high offset short cementless stems. Although high offset stems are more frequently aligned in varus, while cortical hypertrophy occurs in wider intramedullary canals.
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Affiliation(s)
- Adrien D'Ambrosio
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - François Bonnomet
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Pierre-Antoine Debordes
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | | | | | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Matthieu Ehlinger
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Henri Favreau
- Department of Orthopaedic Surgery and Traumatology, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
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Oommen AT. Offset restoration in total hip arthroplasty: Important: A current review. World J Orthop 2024; 15:696-703. [PMID: 39165871 PMCID: PMC11331330 DOI: 10.5312/wjo.v15.i8.696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/29/2024] [Accepted: 07/08/2024] [Indexed: 08/13/2024] Open
Abstract
Normal vertical and horizontal offset is essential for hip biomechanics, muscle functioning and gait pattern. Total hip arthroplasty (THA) should aim to restore normal offset with implantation of femoral and acetabular components. This would be possible with proper preoperative planning, templating and ensuring implant options are available for offset restoration. Templating is essential for understanding the vertical and horizontal offset change, especially in hip arthritis presenting late with significant limb length discrepancy at THA. Planning should include appropriate soft tissue releases and the use of ideal implants to achieve restoration of horizontal and vertical offset. Under correction of horizontal offset at THA for fracture neck of femur could result in abductor fatigue, limp and increased wear. Restoration of horizontal offset is imperative at THA for a fractured neck of the femur to achieve optimal abductor function. Horizontal offset is necessary for optimal abductor muscle tension and function. Revision THA for acetabular bone loss would require hip center restoration with the acetabular and femoral offset correction to achieve limb length correction and abductor length. The inability to achieve vertical and horizontal offset correction could lead to dislocation or signs of abductor fatigue. Careful vertical and horizontal femur offset restoration is required for normal hip biomechanics, decreased wear and increased longevity.
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Affiliation(s)
- Anil Thomas Oommen
- Department of Orthopedics, Christian Medical College Hospital, Vellore 632004, India
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Luca DiGiovanni P, Gasparutto X, Armand S, Hannouche D. The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review. EFORT Open Rev 2023; 8:117-126. [PMID: 36916758 PMCID: PMC10026057 DOI: 10.1530/eor-22-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Offsets in the frontal plane are important for hip function. Research on total hip arthroplasty (THA) surgery agrees that increasing femoral offset up to 5 mm could improve functional outcome measures. The literature indicates that global offset is a key parameter that physicians should restore within 5 mm during surgery and avoid decreasing. Substantiated findings on acetabular offset are lacking despite its recognized importance, and the medialization approach must be assessed in light of its shortcomings. Future research, possibly through improved measurement, unified definitions, patient-specific surgical planning, and technology-enhanced surgical control, with specific focus on acetabular offset, is needed to better understand its impact on THA outcomes.
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Affiliation(s)
- Peter Luca DiGiovanni
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Xavier Gasparutto
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stéphane Armand
- Kinesiology Laboratory, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Didier Hannouche
- Division of Orthopaedic Surgery and Musculoskeletal Trauma Care, Surgery Department, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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Kinoshita K, Seo H, Matsunaga T, Doi K, Yamamoto T. Clinical Outcomes for Total Hip Arthroplasty with and without Previous Curved Periacetabular Osteotomy. J Clin Med 2023; 12:jcm12020694. [PMID: 36675623 PMCID: PMC9867272 DOI: 10.3390/jcm12020694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
There are currently no reports on the clinical outcomes after total hip arthroplasty (THA) with previous curved periacetabular osteotomy (CPO), although the outcomes after THA with non-CPO types of periacetabular osteotomy have been reported. This study aimed to clarify the differences in clinical outcomes and radiographic features after THA with or without previous CPO. We performed a retrospective case-control with individual matching study. The participants were 10 patients with 11 hips that underwent cementless THA between October 1998 and October 2018 with previous CPO (osteotomy group). For the control group, we matched age, sex, and follow-up period, and included 32 patients with 33 hips that underwent cementless THA without previous CPO at a 1:3 ratio. The Harris Hip Score (HHS), cup size, position, and alignment, global offset (GO), operative time, perioperative blood loss, frequency of osteophyte removal, and major complications were compared between the two groups. The osteotomy group had no cases with revision surgery and dislocation. No significant differences were found between the two groups as follows: mean HHS, 94.9 points in the osteotomy group versus 92.7 points in the control group at the final follow-up; mean GO, 70.1 mm in the osteotomy group versus 71.4 mm in the control group; cup size, position, and alignment after THA; operative time; and perioperative blood loss. The frequency of osteophyte removal was higher in the osteotomy group. The take-home messages were that the clinical outcomes, including HHS, and radiographic features, including GO, after THA were equivalent in the two groups.
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Di Maro A, Creaco S, Albini M, Latiff M, Merlo M. Radiographic results on acetabular cup placement with the SuperPath technique: a retrospective study of 756 cases. BMC Musculoskelet Disord 2022; 23:101. [PMID: 35101011 PMCID: PMC8802501 DOI: 10.1186/s12891-022-05065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Supercapsular percutaneously assisted total hip (SuperPath) technique is a relatively new minimally invasive approach for total hip arthroplasty (THA). Good clinical outcomes related to its use are reported in the literature. Nonetheless, there are still uncertainties about its validity in terms of radiographic outcomes. Main purpose of the study is to evaluate the effectiveness of the SuperPath in acetabular cup positioning through radiographic evaluation of acetabular inclination angle (IA) and acetabular anteversion (AA) angle within the safe zone described by Lewinnek. The leg length discrepancy (LLD), femoral offset (FO), and acetabular offset (AO) were also measured to ascertain the radiographic effectiveness of SuperPath in the acetabular cup placement. Methods Between January 2016 and December 2019, all SuperPath cases eligible for the study were included. They were operated by three orthopaedic surgeons with long-standing experience in THA via conventional posterolateral approach and who have performed SuperPath training fellowship. The Mann-Whitney U test was used for statistical assessments (p-value < 0.05). Means ± standard deviation (SD) of the radiographic IA and AA were calculated for each year. Results A retrospective analysis of 756 THAs was performed. The average percentage of IA within the Lewinnek’s safe zone was from 80 to 85%, while the average percentage of AA was from 76 to 79%. Both IA and AA showed no statistically significant difference between two consecutive years. Good results, in the ranges of normal values, were also obtained for LLD, FO and AO, with homogeneous outcomes between 1 year and the following one. Conclusion It is possible to achieve good radiographic values of acetabular cup orientation through the SuperPath within the Lewinnek’s safe zone. These results are similar to those reported in the literature by authors using SuperPath. Low rate (0,3%) of hip dislocations were reported. Therefore, the SuperPath technique represents a good alternative THA approach. Nevertheless, there is not a statistically significant improvement in these radiographic parameters over a four-year time. Level of evidence Level IV, retrospective study.
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Affiliation(s)
- Agostino Di Maro
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy.
| | - Santo Creaco
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
| | - Mattia Albini
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Mahfuz Latiff
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Fondazione Macchi Varese, ASST Sette Laghi, Viale Borri 57, Varese, Italy
| | - Marco Merlo
- Department of Orthopaedics and Trauma Surgery of Ospedale di Circolo Busto Arsizio, ASST Valle Olona, Via Arnaldo da Brescia,1, Varese, Italy
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Peng L, Ma J, Zeng Y, Wu Y, Si H, Shen B. Clinical and radiological results of high offset tri-lock bone preservation stem in unilateral primary total hip arthroplasty at a minimum follow-up of 3 years. J Orthop Surg Res 2021; 16:635. [PMID: 34689823 PMCID: PMC8543806 DOI: 10.1186/s13018-021-02787-7] [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: 09/13/2021] [Accepted: 10/11/2021] [Indexed: 02/08/2023] Open
Abstract
Background Although the high offset Tri-Lock bone preservation stem (BPS) was used widely, few studies explored the clinical and radiological results. The purpose of this study was to determine the clinical and radiological results of high offset Tri-Lock BPS in unilateral primary total hip arthroplasty (THA) at a minimum follow-up of 3 years. Methods 55 patients who underwent cementless THA with high offset Tri-lock BPS from 2017 to 2018 were followed for a minimum follow-up of 3 years. Patients were assessed clinically for complications, Harris hip score (HHS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Oxford Hip Score (OHS). Femoral offset (FO), acetabular offset (AO), hip offset (HO), HO difference, and leg length discrepancy (LLD) were measured on the anteroposterior (AP) pelvic radiograph. Standard pelvic AP and lateral radiographs were used to evaluate for evidence of bone ingrowth, stem subsidence, stem alignment, radiolucent line around the stem, osteolysis, loosening, ectopic ossification, and femoral stress shielding. Results No patients reported complications during hospitalization nor the follow-up period. At a mean follow-up of 42.5 months, the mean HHS, WOMAC, and OHS scores showed a significant improvement from preoperative to the latest follow-up. No patients reported thigh pain. No revision nor sign of radiographic loosening had been detected. The high offset Tri-Lock BPS significantly improved the FO and HO postoperatively. HO difference and LLD were balanced postoperatively. No sign of stem subsidence, radiolucent line, osteolysis, loosening, ectopic ossification, nor severe stress shielding (more than grade 3–4) were observed at the latest follow-up. Conclusion The high offset Tri-Lock BPS demonstrated excellent clinical and radiographic outcomes at a minimum follow-up of 3 years. HO difference and LLD between legs decreased significantly and achieved balance postoperatively. Long-term follow-up is required for a definitive conclusion.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Jun Ma
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37# Guoxue Road, Chengdu, 610041, Sichuan Province, People's Republic of China.
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