The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review

DiGiovanni, Peter Luca; Gasparutto, Xavier; Armand, Stéphane; Hannouche, Didier

doi:10.1530/eor-22-0039

Cited by 9 publications

(7 citation statements)

References 42 publications

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“…In this case, the acetabular preparation consists of reaming down to the true floor, thus medializing the hip’s rotation center and decreasing acetabular offset. This medialization dwindles the body weight’s lever arm during monopodial stance, diminishing the resultant force on the femoral head if every anatomic formation is intact[ 9 ]. Current literature focuses on reducing the acetabular offset in relation to the femoral offset, extensive criticism of this guideline has been observed[ 10 - 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Orthopaedic surgeons should ream the medial cotyloid cavity to the floor until a suitable component size for implantation. This triggers medial and superior displacement of the hip’s rotational center to achieve a comparatively normal acetabular offset and rotation center[ 9 ]. Additionally, the exact preoperative planning reduces surgical time and number of complications[ 3 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective study of 277 patients undergoing primary THA by Pfeufer et al [ 5 ] revealed a relation between the acetabular component’s size and radiographically measured contralateral native femoral head’s size, with a discrepancy of 7 mm. Moreover, digital radiographs’ templating accuracy in predicting the implant size has been gauged and found to be sufficiently good[ 8 , 9 ]. Nonetheless, digital templating demands special software provided by the companies.…”

Section: Discussionmentioning

confidence: 99%

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Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty

Karampinas,

Vlamis,

Galanis

et al. 2024

World J Methodol

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BACKGROUND Selecting the optimal size of components is crucial when performing a primary total hip arthroplasty. Implanting the accurate size of the acetabular component can occasionally be exacting, chiefly for surgeons with little experience, whilst the complications of imprecise acetabular sizing or over-reaming can be potentially devastating. AIM To assist clinicians intraoperatively with a simple and repeatable tip in elucidating the ambivalence when determining the proper acetabular component size is not straightforwardly achieved, specifically when surgeons are inexperienced or preoperative templating is unavailable. METHODS This method was employed in 263 operations in our department from June 2021 to December 2022. All operations were performed by the same team of joint reconstruction surgeons, employing a typical posterior hip approach technique. The types of acetabular shells implanted were: The Dynasty® acetabular cup system (MicroPort Orthopedics, Shanghai, China) and the R3® acetabular system (Smith & Nephew, Watford, United Kingdom), which both feature cementless press-fit design. RESULTS The mean value of all cases was calculated and collated with each other. We distinguished as oversized an implanted acetabular shell when its size was > 2 mm larger than the size of the acetabular size indicator reamer (ASIR) or when the implanted shell was larger than 4 mm compared to the preoperative planned cup. The median size of the implanted acetabular shell was 52 (48–54) mm, while the median size of the preoperatively planned cup was 50 (48–56) mm, and the median size of the ASIR was 52 (50–54) mm. The correlation coefficient between ASIR size and implanted acetabular component size exhibited a high positive correlation with r = 0.719 (P < 0.001). Contrariwise, intraoperative ASIR measurements precisely predicted the implanted cups’ size or differed by only one size (2 mm) in 245 cases. CONCLUSION In our study, we demonstrated that the size of the first acetabular reamer not entering freely in the acetabular rim corroborates the final acetabular component size to implant. This was also corresponding in the majority of the cases with conventional preoperative templating. It can be featured as a valid tool for avoiding the potentially pernicious complications of acetabular cup over-reaming and over-sizing in primary total hip arthroplasty. It is a simple and reproducible technical note useful for confirming the predicted acetabular cup size preoperatively; thus, its application could be considered routinely, even in cases where preoperative templating is unavailable.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty

Karampinas,

Vlamis,

Galanis

et al. 2024

World J Methodol

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show abstract

“…12 FO was defined as the distance from the center of the femoral head to the bisector of the long axis of the femur. 13 Acetabular offset was defined as the distance from the center of the femoral head to the true floor of acetabulum. 14 Worlicek et al revealed the relationship between global FO and restoration of leg length and trochanteric pain syndrome.…”

Section: Introductionmentioning

confidence: 99%

“…Global FO was defined as the sum of the acetabular offset and FO 12 . FO was defined as the distance from the center of the femoral head to the bisector of the long axis of the femur 13 . Acetabular offset was defined as the distance from the center of the femoral head to the true floor of acetabulum 14 .…”

Section: Introductionmentioning

confidence: 99%

The Role of Global Femoral Offset in Total Hip Arthroplasty with High Hip Center Technique

Yang

Wang

et al. 2023

Orthopaedic Surgery

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ObjectiveThe high hip center (HHC) technique has been proposed for the treatment of patients with developmental dysplaisa of the hip (DDH) who have an acetabular bone defect. However, the importance of global femoral offset (FO) in the application of this technique has not been sufficiently appreciated. Our goals were to confirm that the HHC technique is feasible in the treatment of patients with DDH and to assess the function of global FO in this procedure.MethodsWe retrospectively analyzed 73 patients who underwent total hip arthroplasty using high hip center technique for unilateral DDH at our hospital between January 2014 and June 2019. According to global FO, the patients were split into three groups: increased FO group (increment greater than 5 mm), restored FO group (restoration within 5 mm) and decreased FO group (reduction greater than 5 mm). Patients' medical records and plain radiographs were reviewed. One‐way ANOVA was used to compare radiographic outcomes and Harris hip score (HHS). Paired t‐test was used to assess preoperative and postoperative HHS and leg length discrepancy. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp was evaluated with Fisher's exact test.ResultsThe average follow‐up time was 7.5 ± 1.4 years. The patients' HHS and leg length discrepancy were significantly improved (p < 0.05). In terms of vertical acetabular height, abductor arm, postoperative leg length difference, and acetabular cup inclination, there was no statistically significant difference between the three groups. At the last follow‐up, HHS was significantly higher in the restored FO group than in the decreased FO and increased FO groups. Trochanteric pain syndrome occurred in 15.0% and Trendelenburg sign and postoperative limp in 8.2% of all patients, respectively. Trochanteric pain syndrome, Trendelenburg sign and postoperative limp did not differ significantly across the three groups. One patient in increased FO group underwent revision for dislocation 6 years after surgery.ConclusionThe HHC technique is an alternative technique for total hip arthroplasty in patients with acetabular bone abnormalities, according to the results of the mid‐term follow‐up. Also, controlling the correction of the global femoral offset to within 5 mm may lead to better clinical outcomes.

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Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be?

Vorimore,

Innmann,

Mavromatis

et al. 2024

The Journal of Arthroplasty

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The modern state of femoral, acetabular, and global offsets in total hip arthroplasty: a narrative review

Cited by 9 publications

References 42 publications

Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty

Technical note for intraoperative determination of proper acetabular cup size in primary total hip arthroplasty

The Role of Global Femoral Offset in Total Hip Arthroplasty with High Hip Center Technique

Impact of Offset and Leg Length on Functional Outcomes Post-Total Hip Arthroplasty: How Accurate Should Coronal Reconstruction Be?

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