Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem – stem or cup positioning?

Al-Amiry, Bariq; Mahmood, Sarwar; Krupić, Ferid; Sayed-Noor, Arkan S.

doi:10.1177/0284185116684676

Cited by 27 publications

(19 citation statements)

References 25 publications

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“…The hip abductor muscles lever arm is in fact strictly dependent by implant positioning which determines the reconstruction of the center of rotation, as well as GO. Al-Amiry et al [1] showed that common errors in LL are mainly caused by improper femoral stem positioning, while global FO reduction results from improper positioning of both the femoral stem and the acetabular cup. According to Bonnin et al [20] GO should be restored to the native anatomy.…”

Section: Discussionmentioning

confidence: 99%

“…The hip abductor muscles lever arm, which is mechanically the distance between the center of rotation of the hip and the insertion point of the muscles, is in fact strictly dependent by implant positioning which determines the reconstruction of the center of rotation, as well as the global hip offset or global femoral offset (GO) [1]. GO is the distance from the anatomical axis of the femur to the medial margin of the acetabulum and it is usually defined as the sum of the femoral offset (FO) and the acetabular offset (AO) [1]. FO is defined as the distance from the center of rotation of the femoral head to the anatomical axis of the femur [2].…”

Section: Introductionmentioning

confidence: 99%

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Restoring global offset and lower limb length with a 3 offset option double-tapered stem

Biggi

Banci²,

Tedino

et al. 2020

BMC Musculoskelet Disord

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Background A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing. Methods From a consecutive series of 201 patients (201 hips) underwent primary cementless THA in our center with a minimum 3-year follow up, 80 patients (80 hips) were available for complete radiographic evaluation for GO and limb length (LL) and clinical evaluation with Harris hip score (HHS). All patients received the same femoral stem with three different offset options (option A with – 5 mm offset, option B and option C with + 5 mm offset, constant for each sizes) without changing stem length. Results Mean GO significantly increased by + 3 mm (P < 0.05) and mean LL significantly decreased by + 5 mm (P < 0.05) after surgery, meaning that postoperatively the limb length of the operated side increased by + 5 mm. HHS significantly improved from 56.3 points preoperatively to 95.8 postoperatively (P < 0.001). Offset option A was used in 1 hip (1%), B in 59 hips (74%) and C in 20 hips (25%). Conclusions The femur is lateralized with a mean of + 5 mm after surgery than, the native anatomy, whatever type of stem was used. Thus, the use of this 3-offset options femoral stem is effective in restoring the native biomechanical hip parameters as GO, even if 2 offset options were considered sufficient to restore GO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Restoring global offset and lower limb length with a 3 offset option double-tapered stem

Biggi

Banci²,

Tedino

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

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“…No patient had leg-length discrepancy after surgery of more than 10 mm, which has been referenced as a critical factor for symptoms such as back pain, limp, stiffness, hip dislocation and early failure [15], lower patient satisfaction, more frequent use of walking aids [16,17], and gait disorders [18]. Furthermore, previous research has indicated that leg-length discrepancy is strongly related to the femoral component position [18,19]. Our results indicate that the discrepancy between the stem and final rasp positions could have a small effect on the leg length, but this could be mitigated intraoperatively, as we described before.…”

Section: Discussionmentioning

confidence: 99%

Discrepancy of Trial Rasp and Femoral Stem Relative Position Within the Femoral Canal of a Coated Tapered System: An Intraoperative, Intrapatient Controlled Study

et al. 2020

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Background: For a successful total hip arthroplasty, the final position of the trial rasp should be adopted by the femoral stem to achieve correct positioning. This study aimed to characterize the discrepancy of the stem and rasp position in vivo of a widely used dual-tapered straight stem with rectangular cross section that is known to have an oversized stem with respect to the rasp. Methods: The distances between the tip of the greater trochanter and the shoulder of the implant and rasp were measured on 39 intraoperatively acquired fluoroscopic image pairs. Leg-length discrepancy was also measured clinically before and after surgery. Results: A paired t-test showed a significant average protrusion of the femoral stem with respect to the final rasp position of 2.63 mm (standard deviation ¼ 2.3 mm, P < .001), while 88% of the cases had no leg-length discrepancy after surgery. The quantified stem protrusion was statistically significant but did not reach clinical relevance and was easily mitigated in our study. Conclusions: The quantified stem protrusion appears to be clinically manageable, as only 2 cases required attenuation of stem positioning: in one case by the use of a femoral head with a shorter neck and in the other case by rerasping the femoral bed. Neither case was associated with the most extreme differences in position of the stem with respect to the final rasp. In addition, the used stem shows good overall outcomes in other studies. It appears that factors other than stem and rasp position play a critical role to the surgeon and for total hip arthroplasty success.

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“…Mild limb lengthening was defined as 2 cm.Mild limb lengthening (MLL): The limb lengthening referred to the sum of preoperative limb shortening and postoperative limb lengthening (Fig. 1B) [16]. In this study, MLL was defined as lengthening by 2 cm.Valgus deformity of the knee (KV): The KV was defined as a preoperative femoral-tibial angle of ≤170°, leaving to valgus knee (Fig.…”

Section: Methodsmentioning

confidence: 99%

“…Mild limb lengthening (MLL): The limb lengthening referred to the sum of preoperative limb shortening and postoperative limb lengthening (Fig. 1B) [16]. In this study, MLL was defined as lengthening by 2 cm.…”

Section: Methodsmentioning

confidence: 99%

Plain radiography findings to predict dislocation after total hip arthroplasty

Liu

Cheng

Dong

et al. 2019

Journal of Orthopaedic Translation

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Background With the improvements of modern surgical techniques and hip prosthesis, the causes for dislocation after total hip arthroplasty (THA) have changed. The aim of this retrospective analysis was to identify new plain radiography findings to predict dislocation after THA. Methods Five thousand five hundred thirteen consecutive primary THAs performed between January 2000 and December 2014 were reviewed through a nested case–control study design. Among them, 38 patients with 39 hip dislocations (dislocation group) were selected and matched to 78 hips in 78 patients without dislocation (control group). The factors that might influence the prosthetic stability were identified by univariate analyses, and a multivariate logistic regression analysis was performed to determine the odds ratio of each factor. Results The difference of the cup position was not statistically significant. The newly identified risk factors were the following: preoperative hip adduction deformity combined with limb lengthening of 2 cm postoperatively; a knee valgus combined with pelvic obliquity deformity and bilateral pathological hips. Conclusions Patients with soft tissue imbalance, across joint deformity around hips and bilateral pathological hips seem more predisposed to suffer from dislocation after THA. Appropriate surgical intervention strategies along with meticulously postoperative management may help preventing dislocation after THA. The translational potential of this article A better understanding of the probable causes of dislocation after THA proposed a new clinical application of plain radiography. This radiography-related clinical research may reveal the novel mechanism of dislocation after THA and new preventive measures.

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Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem – stem or cup positioning?

Cited by 27 publications

References 25 publications

Restoring global offset and lower limb length with a 3 offset option double-tapered stem

Restoring global offset and lower limb length with a 3 offset option double-tapered stem

Discrepancy of Trial Rasp and Femoral Stem Relative Position Within the Femoral Canal of a Coated Tapered System: An Intraoperative, Intrapatient Controlled Study

Plain radiography findings to predict dislocation after total hip arthroplasty

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