Are There Gender-Specific Errors in Restoration of Hip Biomechanics That Affect Outcome Following Total Hip Arthroplasty?

Warnock, Jonathan M.; Karayiannis, Paul N.; Gallagher, Nicola; Hill, Janet; Beverland, David

doi:10.1016/j.arth.2019.12.014

Cited by 11 publications

(16 citation statements)

References 21 publications

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“…In order to evaluate possible confounder, we also carried out the logistic regression for other variables such as age, gender or BMI. Warnock et al [ 32 ] detected a lengthening in cementless THA in females due to a greater femoral height discrepancy leading to reduced delta gain in Oxford hip score (OHS) and pain scores. Al-Amiry et al [ 33 ] detected a negative effect of increased BMI in restoration of leg length but not on restoration of femoral offset.…”

Section: Discussionmentioning

confidence: 99%

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

et al. 2021

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Background Correct reconstruction of hip offset (HO) and leg length are important for clinical–functional outcome and patient satisfaction in total hip arthroplasty (THA). The morphology of the proximal femur can pose a risk for increased leg length difference (LLD) in cementless straight-stem THA. We therefore wanted to evaluate, if this is also applicable in THA with a cementless meta-diaphyseal short stem. Methods In a retrospective study, 106 patients (index surgery 2014–2019) with unilateral THA and a morphologically healthy hip as a reference (Kellgren–Lawrence ≤ 1) were included. The same cementless short stem with meta-diaphyseal fixation and cementless press-fit cup was implanted. The proximal femur was rated by Dorr’s classification, and subgroups were formed afterward. Measurements were carried out on preoperative and 3 months postoperative anterior–posterior radiographs of the pelvis. Kruskal–Wallis test, Fisher’s exact test and binary logistic regression were performed to evaluate the influence of the anatomical shape on postoperative leg length difference and offset reconstruction. Results The Dorr type did not show any significance influence on LLD (p = 0.532), or postoperative difference in femoral offset (p = 0.243), acetabular offset (p = 0.106) and hip offset (p = 0.698). Stem alignment (p = 0.705) and canal fill indices (CFI I: p = 0.321; CFI II: p = 0.411; CFI III: p = 0.478) were also without significant differences. Logistic regression did not show any significant increased risk for a LLD ≥ 5 mm or ≥ 10 mm as well as HO ≥ 5 mm or ≥ 10 mm. Conclusion Reconstruction of hip offset and postoperative leg length difference is not negatively influenced by Dorr type, canal flare index, cortical index and canal-to-calcar ratio in cementless short-stem THA. Implant positioning and canal fill are also not negatively affected by the anatomical shape of the proximal femur. Level of evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

et al. 2021

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“…in severe dysplasia, patient-reported outcome measures (PROMS) are improved by restoring the natural centre of the hip joint. 23 A magnetic resonance imaging (MRI) study from our unit showed there is marked individual variation in the orientation of peri-acetabular landmarks, particularly in the range of acetabular version (range 5.3-36.1°) compared to the narrower range for acetabular inclination (range 38.4-50.3°). 24 This raises the question of whether a set target for orientation of cup anteversion is appropriate for every patient.…”

Section: Discussionmentioning

confidence: 97%

“…in severe dysplasia, patient-reported outcome measures (PROMS) are improved by restoring the natural centre of the hip joint. 23…”

Section: Discussionmentioning

confidence: 99%

A conservative approach to dislocation following total hip arthroplasty: a review of 8606 hips

2020

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Patients and methods: We present the data on 8606 total hip arthroplasty (THA) procedures carried out in 7818 patients through a posterior approach between 1998 and 2017. Results: 218 hips (2.5%) suffered at least 1 dislocation with dislocation rates declining from 6.2% from 1998 to 2002 to 1.5% from 2003 to 2017. Overall, 92 hips (1.06%) required revision surgery but of these, only 5 (0.06%) had a full revision of both components with the remaining 87 requiring intervention only on the acetabular side. None have had a pseudo-arthrosis; none were left dislocated and all remain stable to date. Conclusions: In patients who have a second dislocation within 3 months of their primary surgery we recommend a spica or long leg cylinder cast to reduce the need for revision surgery. We propose an algorithm to manage instability with less aggressive operative treatment in this often-elderly patient population with the potential for less physiological insult and significant cost savings.

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“…Even when FHC is raised but is insufficient to result in the perception of a long leg, outcome has been shown to be compromised. 16 This is particularly evident in small femurs and hence more common in females. 16…”

Section: Discussionmentioning

confidence: 99%

Using a ring to locate femoral head centre in total hip arthroplasty

et al. 2021

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Aims: Traditional methods of determining femoral head centre (FHC) during total hip arthroplasty (THA) rely on measuring the distance from a fixed point on the femur or using a calliper. The aim of this experiment was to investigate how accurately a simple circular ring could locate FHC. Methods: 144 consecutively available femoral heads (FHs) were collected from patients undergoing THA. Each FH was orientated and mounted on a Sawbone, to create a model of its position on a proximal femur. The ring was applied to the posterior aspect of the FH and a head-centre pin (HCP) was then drilled into the FH and the ring removed, leaving the HCP in place. Each FH was then photographed normal to the axis of the HCP. A MATLAB analysis program then assessed the accuracy of the ring in locating FHC. Results: Mean location accuracy for FHC was 1.77 (range 0.07–5.83) mm with 97.2% within 4 mm and all but 1 within 5 mm. Conclusions: This ring device located FHC to within 4 mm in 97% of a series of osteoarthritic FHs. This indicates that the posterior aspect of the FH maintains its sphericity late into the osteoarthritic process. Having a simple FHC location device during THA would be of value to control leg length and offset when using the posterior approach.

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Are There Gender-Specific Errors in Restoration of Hip Biomechanics That Affect Outcome Following Total Hip Arthroplasty?

Cited by 11 publications

References 21 publications

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

The morphology of the proximal femur in cementless short-stem total hip arthroplasty: No negative effect on offset reconstruction, leg length difference and implant positioning

A conservative approach to dislocation following total hip arthroplasty: a review of 8606 hips

Using a ring to locate femoral head centre in total hip arthroplasty

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