Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty

McGrory, Brian J.; Morrey, B.F.; Cahalan, Thomas D.; An, Kai Nan; Cabanela, Miguel E.

doi:10.1302/0301-620x.77b6.7593096

Cited by 437 publications

(312 citation statements)

References 8 publications

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“…For patients who lived too far away for direct followup, we recommended establishing care with a local orthopaedic surgeon. Overall, the length of followup (242 patients; 277 hips) was less than 1 year for 49 patients (20 2 of the patients unaccounted for at 5 years, and knowing that patients who are lost to followup are more likely to have had complications or revisions, we must consider our findings a best-case analysis with this implant. The actual risk of reoperation may be even greater than the 19.5% that we observed here.…”

Section: Discussionmentioning

confidence: 99%

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High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed. Questions/purposes We asked: (1) What is the survivorship of the PROFEMUR 1 bimodular femoral neck stems? (2) What are the modes of failure of this bimodular femoral neck implant? (3) What are the major risk factors for the major modes of failure of this device?Methods Between 2003 and 2009, we used one family of bimodular femoral neck stems for all primary THAs (PRO-FEMUR 1 Z and PROFEMUR 1 E). During this period, 277 THAs (in 242 patients) were performed with these implants. One hundred seventy were done with the bimodular PROFE-MUR 1 E (all are accounted for here), and when that implant was suspected of having a high risk of failure, the bimodular PROFEMUR 1 Z was used instead. One hundred seven THAs were performed using this implant (all are accounted for in this study). All bearing combinations, including metal-on-metal, metal-on-polyethylene, and ceramic-on-ceramic, are included here. Data for the cohort included patient demographics, BMI, implant dimensions, type of articular surface, length of followup, and C-reactive protein serum level. We assessed survivorship of the two stems using Kaplan-Meier curves and determined the frequency of the different modes of stem failure. For each of the major modes of failure, we performed binary logistic regression to identify associated risk factors. Results Survivorship of the stems, using aseptic revision as the endpoint, was 85% for the patients with the PROFE-MUR 1 E stems with a mean followup of 50 months (range, 1-125 months) and 85% for the PROFEMUR 1 Z with a mean followup of 50 months (range, 1-125 months)(95% CI, 74-87 months). The most common modes of failure were loosening (9% for the PROFEMUR 1 E), neck fracture (6% for the PROFEMUR 1 Z and 0.6% for the PROFEMUR 1 E), metallosis (1%), and periprosthetic fracture (1%). Only the bimodular PROFEMUR 1 E was associated with femoral stem loosening (odds ratio [OR] =1.1; 95% CI, 1.04-1.140; p = 0.032). Larger head (OR = 3.2; 95% CI, 0.7-14; p = 0.096), BMI (OR = 1.19; 95% CI, 1-1.4; p = 0.038) and total offset (OR = 1.83; 95% CI, 1.13-2.9; p = 0.039) were associated with neck fracture.

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Section: Discussionmentioning

confidence: 99%

“…Hip offset and length are known to affect the forces around the joint, stability of the hip, and even longevity of the bearing surface [1,6,20]. A decrease or increase greater than 5 mm in offset can negatively affect the wear of the contact surfaces by increasing the joint reaction forces [24,25].…”

Section: Introductionmentioning

confidence: 99%

High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…At the hip joint, the mean ROM of flexion was 100.5° for the healthy individuals in the older group. Nevertheless, the reported mean maximum ROM of flexion achieved following total hip arthroplasty (THA) was 99.8° (SD=15.3°) with a range of 48° to 121° (Krushell et al, 1991;McGrory et al, 1995). This implies that the postoperative maximum ROM of flexion of THA is close to the flexion value necessary for common kneeling activity.…”

Section: Discussionmentioning

confidence: 99%

Kinematics of hip, knee, ankle of the young and elderly Chinese people during kneeling activity

Zhou

Wang

Liu

et al. 2012

J. Zhejiang Univ. Sci. B

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Abstract:Objective: The purpose of this study was to measure the kinematics of the lower limbs of Chinese people during normal kneeling activity, as such data could be valuable in designing joint prosthesis and arthroplasty that meet the needs of Chinese citizens' daily activities. Methods: Thirty young and twenty elderly Chinese participants with no personal history of joint diseases were recruited, and matched by age (average age: 23.8 years for the young group, 60.8 years for the elderly group). Each participant performed six trials during which three-dimensional (3D) kinematics data were collected and the means of the 3D angles of the ankle, knee, and hip joints of two groups were calculated. Results: There were no obvious differences between the two groups in the knee and ankle joints. The mean range of knee flexion was 139.6° for the young group and 140.9° for the elderly group. The mean range of ankle flexion was 35.7° for the young group and 37.6° for the elderly group. The maximal eccentric flexion at the hip joint was 67.5° for the young group compared to 100.5° for the elderly group. Conclusions: The elderly uses more hip flexion angles than the young when assuming the kneeling posture. The ranges of motion obtained during kneeling activity are greater than the reported mean ranges of motion achieved following joint arthroplasty. The data could be valuable in establishing criteria for lower limb prosthetics and rehabilitation protocol for the Chinese population.

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“…Jani et al (1997) showed that taper variations such as taper design and taper surface finish have a significant impact on the fretting behaviour at the THR taper junction. Femoral head offsets are also known to likely have an effect on the generation of wear debris at the taper junction (McGrory et al, 1995). Langton et al (2012) have shown varus stems, larger head diameters and head offsets increase the horizontal moment arm acting at the taper junction, which increases the fretting wear rate at this junction.…”

Section: Introductionmentioning

confidence: 99%

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Ashkanfar

Langton

Joyce

2017

Journal of the Mechanical Behavior of Biomedical Materials

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A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis.http://researchonline.ljmu.ac.uk/5442/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Chromium femoral heads, which had been in service for 5.1 years in average, to validate the FE analyses. It was found that a large taper mismatch (e.g. 9.12´ ) results in a high wear rate (2.960mm 3 per million load cycles). Such wear rates can have a major negative effect on the clinical outcomes of these implants. It was also found that even a slight reduction in mismatch significantly reduced the magnitude of the wear rates (0.069mm 3 per million load cycles on average for 6´ taper mismatch). It is recommended that the cone angles of femoral head and femoral trunnion should be manufactured to produce a taper mismatch of less than 6´ at the taper junction.

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Effect of femoral offset on range of motion and abductor muscle strength after total hip arthroplasty

Cited by 437 publications

References 8 publications

High Risk of Failure With Bimodular Femoral Components in THA

High Risk of Failure With Bimodular Femoral Components in THA

Kinematics of hip, knee, ankle of the young and elderly Chinese people during kneeling activity

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

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