Femoral-Acetabular Mating: The Effect of Femoral and Combined Anteversion on Cross-Linked Polyethylene Wear

Mayeda, Brian; Haw, Jonathan; Battenberg, Andrew K.; Schmalzried, Thomas P.

doi:10.1016/j.arth.2018.06.003

Cited by 14 publications

(12 citation statements)

References 38 publications

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“…Increased femoral anteversion can be associated with hip instability, redislocation after closed reduction, and subsequent early degenerative arthritis although in patients with unilateral DDH, AA was found to be significantly different between affected and unaffected sides. However, the difference had very limited or no clinical significance, as redislocation/subluxation was not influenced by AA values (44,45).…”

Section: Discussionmentioning

confidence: 93%

Clinical importance and sex differences of the femoral anteversion angle

Kapur

Dračić

Gračić

2019

JHSCI

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Introduction: The Femoral angle of anteversion (FAA) is responsible for the medial and anterior direction of the femoral neck and therefore the femoral head towards the acetabulum. The aim of this study was to determine the difference in FAA between male and female samples, the correlation between the FAA and biomechanically relevant parameters and to provide a review of relevant clinical features related to FAA. Methods: We included 100 human dry femora and analyzed FAA, Angle of Inclination (AI), Femoral Head Diameter (FHD), Femoral Biomechanical Length (FBL) and Linear Condylar Parameters (Epicondylar Breadth Width (EBW), Lateral Condyle Depth and Medial Condyle Depth). The measurements were made using a goniometer, sliding calipers and pieces of colored string. Results: Mean FAA values were 9.84±7.97° and 8.72±8.23° for the male and female samples, respectively (p<0.05). FAA and AI in both male and female correlated negatively (-0.076), while there was a positive correlation between FAA and FHD (0.069), FAA and FBL (0.072), FAA and EBW (0.029), while the correlation was negative between FAA and LCD (-0.072), FAA and MCD (-0.063). Conclusion: The difference in FAA between male and female femora was found to be significant. This finding may help better understanding such as hip impingement, total hip arthroplasty failure, and design of femoral endoprosthesis parts.

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Section: Discussionmentioning

confidence: 93%

Clinical importance and sex differences of the femoral anteversion angle

Kapur

Dračić

Gračić

2019

JHSCI

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“…It is well established that increased acetabular component anteversion and abduction have been associated with increased wear [10] and instability [9]. However, there are recent data to suggest that anatomic restoration of leg length and both femoral and total offset can achieve better hip kinematics [18], as well as improved wear rates [11], stability [19], and abductor muscle function [17]. Most surgeons utilize a combination of acetabular and femoral parameters to achieve anatomic restoration of the hip joint.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies comparing the PA and DAA focus on clinical results, while there are fewer studies evaluating radiographic outcomes [4,8]. Lower dislocation rates and improved wear rates have been identified in implants that are more anatomically positioned regardless of the approach [9][10][11]. It should be noted that most of the comparative studies have focused on cup position but have largely ignored the femoral component with the exception of leg length.…”

Section: Introductionmentioning

confidence: 99%

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

2020

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Background: Total hip arthroplasty (THA) has demonstrated excellent results regardless of the surgical approach. However, the approach used may be a factor in final positioning of implants. We hypothesized that the direct anterior approach (DAA) with fluoroscopy would be associated with more anatomic implant positioning than the posterior approach (PA). Methods: A retrospective review of 200 patients was performed. One hundred patients underwent THA utilizing the PA, and 100 patients, with the DAA. All patients had an anterior-posterior pelvis radiograph preoperatively and postoperatively with a magnification marker present to standardize each radiograph. Exclusion criteria included contralateral THA or any pelvic or femoral deformity. Results: Preoperative radiographs demonstrated identical cohorts with respect to leg length, femoral offset, and total offset. Postoperatively, the DAA achieved more accurate anatomic restoration of leg length (1.6 mm vs 5.5 mm; P < .0001), femoral offset (4.8 mm vs 9.3 mm; P < .0001), and total offset (0.5 mm vs 4.7 mm; P < .0001) compared with the PA. Ideal cup abduction and anteversion were significantly superior to the DAA (96% vs 78%, P ¼ .0002, and 69% vs 24%, P < .0001, respectively). Conclusions: This study is the first to compare anatomic implant positioning between patients undergoing THA with these 2 approaches. All parameters were significantly closer to anatomic implant positioning with the DAA. There are at least 2 potential explanations for this: (1) The DAA implant positioning was performed under fluoroscopic guidance, whereas the PA was not. (2) The PA disrupts the posterior capsule and external rotators, and therefore, increased offset or leg length may be necessary to achieve comparable hip stability with the DAA.

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“…It has been demonstrated in the literature that acetabular cup anteversion is an independent factor influencing XLPE wear. 34,35 However, we were unable to perform this measurement due to inability to visualize the transischial line in all of the hip radiographs. Finally, given our restricted sample size, further investigation is needed to generalize these results to a larger patient population.…”

Section: Limitationsmentioning

confidence: 99%

Mid- to Long-Term Survivorship Analysis of a Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty

Yeroushalmi

Lygrisse

Sharan

et al. 2020

The Journal of Hip Surgery

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The emergence of highly cross-linked polyethylene (HCLPE) has drastically improved survivorship of implants used in total hip arthroplasty (THA), as demonstrated by midterm outcomes. However, there is limited data evaluating long-term outcomes and wear rates of these liners. Therefore, the aim of this study is to evaluate the longest-to-date follow-up of a specific second-generation HCLPE liner, the progression of wear rate, and its relation to acetabular cup positioning. A retrospective study was conducted on patients who underwent THA between January 2001 and December 2005 using a specific second-generation HCLPE liner. Annual liner wear rate (mm/year) was calculated in this group as well as acetabular positioning through abduction angle (degrees). Failures and reason for failures such as periprosthetic fracture, dislocation, and osteolysis were noted when applicable. Forty hips of 35 patients were included in this study with a clinical and radiographic follow-up of 13.4 ± 2.2 years (range: 10.0–16.7 years). Linear and volumetric wear rates were calculated to be 0.037 ± 0.020 mm/year and 22.94 ± 12.07 mm3/year, respectively. No radiographic femoral or acetabular osteolysis was observed in any of the cases. One patient required revision due to complications unrelated to the liner. No significant relationship could be established for acetabular component abduction angle and linear wear rate (p = 0.690, Spearman's rho = 0.03). Our study demonstrates comparable liner wear rates to that of other second-generation HCLPE liners in long-term follow-up. The XLPE liner continues to exhibit minimal progression of linear wear when compared with previous midterm studies and maintains a low rate of postoperative complications requiring revision THA surgery. Further studies are warranted to assess long-term wear and survivorship between this specific liner and comparable HCLPE models.

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Femoral-Acetabular Mating: The Effect of Femoral and Combined Anteversion on Cross-Linked Polyethylene Wear

Cited by 14 publications

References 38 publications

Clinical importance and sex differences of the femoral anteversion angle

Clinical importance and sex differences of the femoral anteversion angle

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy

Mid- to Long-Term Survivorship Analysis of a Second-Generation Highly Cross-Linked Polyethylene in Total Hip Arthroplasty

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