Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation

Forde, Braxton; Engeln, Kathleen; Bedair, Hany; Bene, Nicholas C.; Talmo, Carl T.; Nandi, Sumon

doi:10.1016/j.jor.2018.01.026

Cited by 42 publications

(38 citation statements)

References 20 publications

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“…[20,21] This finding could be due to a more correct reconstruction of hip biomechanics with the incorporation of the CFP prosthesis. [22] He also considered the neck-preserving ratio to be an important factor affecting the prevalence of dislocation.…”

Section: Discussionmentioning

confidence: 99%

Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem

Liu

et al. 2019

Medicine

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The femoral neck-preserving ratio is crucial in arthroplasty with a collum femoris-preserving (CFP) stem. The aim of our study was to analyze the relationships between the neck-preserving ratio and the short-term radiologic and clinical outcomes of patients who underwent total-hip arthroplasty (THA) with a CFP stem.The data of 325 hips from January 2015 to December 2016 were retrospectively reviewed. The demographic and radiologic data before and after surgery were obtained from patients. The neck-preserving ratio was defined as the ratio of the preserved femoral neck length to the preoperative femoral neck length. Correlations between the neck-preserving ratio and the radiologic and clinical outcomes of patients were analyzed.The mean neck-preserving ratio was 66.38 ± 6.91% in the current study. We divided patients into 3 groups according to the neck-preserving ratio: group A (neck-preserving ratio ≤60.00%), group B (60.00% < neck-preserving ratio < 70.00%), group C (neck-preserving ratio ≥70.00%). Radiologic features, including the neck-shaft angle ratio (0.96 ± 0.05), canal fill ratio (0.64 ± 0.07), anterior-posterior offset ratio (1.04 ± 0.10), and lateral offset ratio (2.55 ± 1.56) (ratios of the postoperative values to the preoperative values), and the prevalence of complications was significantly different among the groups (χ2 = 21.173, P < .001). In the correlation analysis, we found a moderate negative correlation between the neck-preserving ratio and neck-shaft angle ratio (r = −0.308, P < .001) and a slight positive correlation of the neck-preserving ratio with the anterior-posterior offset ratio (r = 0.415, P < .001) and the lateral offset ratio (r = 0.164, P = .003). In the linear regression analyses, the neck-preserving ratio was significantly linearly correlated with the neck-shaft angle ratio (B = −0.232, 95% confidence interval [CI] = −0.311 to −0.154, P < .001), anterior-posterior offset ratio (B = 0.589, 95% CI = 0.447–0.730, P < .001), and lateral offset ratio (B = 3.693, 95% CI = 1.256–6.131, P = .003). However, there was no significant linear correlation between the neck-preserving ratio and the canal fill ratio (B = 0.073, 95% CI = −0.033 to 0.180, P = .174). Logistic regression analyses also showed that a sufficient neck-preserving ratio was a protective factor for periprosthetic femoral fractures (odds ratio [OR] = 0.924, 95% CI = 0.859–0.994, P = .035), dislocations (OR = 0.892, 95% CI = 0.796–0.999, P = .048), and thigh pain (OR = 0.886, 95% CI = 0.818–0.960, P = .003).For CFP stems, an insufficient neck-preserving ratio is significantly correlated with poor radiologic and clinical outcomes. Therefore, surgeons should be cognizant to preserve a sufficient femoral neck length during surgery to improve the outcomes for patients undergoing THA with CFP stems.

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Section: Discussionmentioning

confidence: 99%

Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem

Liu

et al. 2019

Medicine

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“…Dislocation of the hip joint after THA is one of the major side complications (2% - 4% after primary total hip arthroplasty) [2,39] and its causes have been studied previously [5,7–20,39–42]. Among patient related factors, the presence of neuromuscular conditions, such as cerebral palsy, muscle dystrophy, dementia and Parkinson’s disease, is one of the main risk factors [39,43].…”

Section: Discussionmentioning

confidence: 99%

“…Among procedure related factors, the measured parameters of component positions, a cup inclination out of the range of 40° ± 10°, a cup anteversion of less than 10° or more than 35°, a stem anteversion out of the range of 14.8° ± 6,01° and a height of hip rotation center outside the range of 2.16 mm ± 9.11 mm, increased the risk of dislocation [8,9,40]. The artificial head size, leg length discrepancy and acetabular inclination were all studied in two separate studies and it was found that these are not statistically important factors predicting dislocation of the femoral head [7,44]. On the other hand, in a study by Berry [5], a smaller size of the prosthesis head was shown to be related to a higher dislocation rate of THA.…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, in a study by Berry [5], a smaller size of the prosthesis head was shown to be related to a higher dislocation rate of THA. In a study by Forde et al [7], it was reported that if the femoral offset was at least 3 mm greater than on the contralateral side, the risk of dislocation was lower [7]. Offset is expressed in the HIPSTRESS model by parameter z.…”

Section: Discussionmentioning

confidence: 99%

“…After revision surgery, the dislocation rate levels at 5.4% in the first year after the operation [6]. Dislocation studies of THA have been performed based on component positioning, with an emphasis on cup orientation [7–10], the effect of artificial head size [5,11,12] and impingement as causes of a prosthesis head dislocation [13–15]. Still more than 50% of dislocations occur when the cup is in the so-called safe zone position [10].…”

Section: Introductionmentioning

confidence: 99%

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Hip stress distribution - Predictor of dislocation in hip arthroplasties. A retrospective study of 149 arthroplasties

et al. 2019

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Dislocation after hip arthroplasty is still a major concern. Recent study of the volumetric wear of the cup has suggested that stresses studied in a one-legged stance model could predispose arthroplasty dislocation. The aim of this work was to study whether biomechanical parameters of contact stress distribution in total hip arthroplasty during a neutral hip position can predict a higher possibility of the arthroplasty dislocating. Biomechanical parameters were determined using 3-dimensional mathematical models of the one-legged stance within the HIPSTRESS method. Geometrical parameters were measured from standard anteroposterior X-ray images of the pelvis and proximal femora. Fifty-five patients subjected to total hip arthroplasty that later suffered dislocation of the head and, for comparison, ninety-four total hip arthroplasties that were functional at least 10 years after the implantation, were included in the study. Arthroplasties that suffered dislocation had on average a 6% higher resultant hip force than the control group (p = 0.004), 11% higher peak stress on the load-bearing area (p = 0.001) and a 50% more laterally positioned stress pole (p = 0.026), all parameters being less favorable in the group of unstable arthroplasties. There was no statistically significant difference in the gradient index or in the functional angle of the weight bearing. Our study showed that arthroplasties that show a tendency to push the head out of the cup in the representative body position—the one-legged stance—are prone to dislocation. An unfavorable resultant hip force, peak stress on the load bearing and laterally positioned stress pole are predictors of arthroplasty dislocation.

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Malunions of the Proximal Femur

Martin

Agarwal²

2020

Malunions

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Restoring femoral offset is the most important technical factor in preventing total hip arthroplasty dislocation

Abstract: Our data suggest restoring femoral offset is the most important technical factor in preventing THA dislocation.

Cited by 42 publications

References 20 publications

Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem

Relationships between the femoral neck-preserving ratio and radiologic and clinical outcomes in patients undergoing total-hip arthroplasty with a collum femoris-preserving stem

Hip stress distribution - Predictor of dislocation in hip arthroplasties. A retrospective study of 149 arthroplasties

Malunions of the Proximal Femur

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