Femoral stem sagittal balance - Do we need a new entry point?

Rozis, Meletis; Bakalakos, Mathaios; Polyzois, Vasilios D.; Vlamis, John; Pneumaticos, Spiros G.

doi:10.22540/jrpms-02-039

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Similar to our results, Worlicek et al 15 , 21 reported that the femoral neck osteotomy height did not correlate with postoperative stem anteversion, varus/valgus alignment, or tilt, for non‐DDH hips. The study by Rozis et al 22 found that if the classical femoral neck osteotomy technique were adopted, a posterior entry point and penetration of the posterior cortex of the femoral neck would be required to achieve a balanced alignment of the straight stem. Therefore, if a neutral stem is achieved in the coronal and sagittal planes, the height of the femoral neck osteotomy will have no significant effect on the anteversion of the straight stem.…”

Section: Discussionmentioning

confidence: 99%

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Hu,

Sun,

Zhang

et al. 2024

Orthopaedic Surgery

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BackgroundPreoperative evaluation of femoral anteversion to predict postoperative stem anteversion aids the selection of an appropriate prosthesis and optimizes the combined anteversion in total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). The conventional prediction methods are based on the femoral anteversion measurement at the location of the femoral head and/or neck. However, varied differences between femoral anteversion and postoperative stem anteversion were demonstrated. This study investigated the predictive role of a new method based on the principle of sagittal three‐point fixation.MethodsFrom January 2017 to December 2018, a total of 133 DDH hips that underwent THA were retrospectively analyzed. There were 76 Crowe type I, 27 type II, and 30 type III hips. The single‐wedge stem was used in 49 hips, and the double‐wedge stem was used in 84 hips. Preoperative native femoral anteversion at the femoral head–neck junction, anterior cortex anteversion at 2 levels of the lesser trochanter, posterior cortex anteversion at 5 levels of the femoral neck, and postoperative stem anteversion were measured using two‐dimensional computed tomography. Predictive anteversion by the new method was calculated as the average anteversion formed by the anterior cortex at the lesser trochanter and the posterior cortex at the femoral neck.ResultsFor hips with different neck heights, different Crowe types, different stem types, or different femoral anteversions, native femoral anteversion showed widely varied differences and correlations with stem anteversion, with differences ranging from −1.27 ± 8.33° to −13.67 ± 9.47° and correlations ranging from 0.122 (p = 0.705, no correlation) to 0.813. Predictive anteversion formed by the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base showed no significant difference with stem anteversion, with less varied differences (0.92 ± 7.52°) and good to excellent correlations (r = 0.826).ConclusionAdopting our new method, predictive anteversion, measured as the average anteversion of the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base, predicted postoperative stem anteversion more reliably than native femoral anteversion.

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Section: Discussionmentioning

confidence: 99%

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Hu,

Sun,

Zhang

et al. 2024

Orthopaedic Surgery

View full text Add to dashboard Cite

show abstract

“…Similar to our results, Worlicek et al [15,21] reported that the femoral neck osteotomy height did not correlate with postoperative stem anteversion, varus/valgus alignment, or tilt, for non-DDH hips. The study by Rozis et al [22] found that if the classical femoral neck osteotomy technique were adopted, a posterior entry point and penetration of the posterior cortex of the femoral neck would be required to achieve a balanced alignment of the straight stem. Therefore, if a neutral stem is achieved in the coronal and sagittal planes, the height of the femoral neck osteotomy will have no signi cant effect on the anteversion of the straight stem.…”

Section: Discussionmentioning

confidence: 99%

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Sun

Zhang

et al. 2023

Preprint

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Background Preoperative evaluation of femoral anteversion to predict postoperative stem anteversion aids the selection of an appropriate prosthesis and optimizes the combined anteversion in THA for developmental dysplasia of the hip (DDH). The conventional prediction methods are based on the femoral anteversion measurement at the location of the femoral head and/or neck. However, varied differences between femoral anteversion and postoperative stem anteversion were demonstrated. This study investigated the predictive role of a new method based on the principle of sagittal three-point fixation. Methods A total of 133 DDH hips that underwent THA were retrospectively analyzed. There were 76 Crowe type I, 27 type II and 30 type III hips. The single-wedge stem was used in 49 hips, and the double-wedge stem was used in 84 hips. Preoperative native femoral anteversion at the femoral head-neck junction, anterior cortex anteversion at 2 levels of the lesser trochanter, posterior cortex anteversion at 5 levels of the femoral neck, and postoperative stem anteversion were measured using two-dimensional computed tomography. Predictive anteversion by the new method was calculated as the average anteversion formed by the anterior cortex at the lesser trochanter and the posterior cortex at the femoral neck. Results For hips with different neck heights, different Crowe types, different stem types, or different femoral anteversions, native femoral anteversion showed widely varied differences and correlations with stem anteversion, with differences ranging from − 1.27 ± 8.33° to -13.67 ± 9.47° and correlations ranging from 0.122 (P = 0.705, no correlation) to 0.813. Predictive anteversion formed by the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base showed no significant difference with stem anteversion, with less varied differences (0.33 ± 7.59° to 2.76 ± 7.02°) and good to excellent correlations (r = 0.672–0.858). Conclusion Adopting our new method, predictive anteversion, measured as the average anteversion of the anterior cortex at the lesser trochanter proximal base and posterior cortex 10 mm above the lesser trochanter proximal base, predicted postoperative stem anteversion more reliably than native femoral anteversion.

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Is Posterior Femoral Neck Cortex an Obstacle in Achieving Sagittal Plane Balance of Uncemented Straight Femoral Stem?

Mandal

Arora

Krishna

et al. 2023

JOIO

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Femoral stem sagittal balance - Do we need a new entry point?

Cited by 3 publications

References 18 publications

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

A New Method to Predict Postoperative Stem Anteversion in Total Hip Arthroplasty for Developmental Dysplasia of the Hip

Is Posterior Femoral Neck Cortex an Obstacle in Achieving Sagittal Plane Balance of Uncemented Straight Femoral Stem?

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