The role of the femoral component orientation on dislocations in THA: a systematic review

Erp, Joost H J van; Snijders, Thom E; Weinans, Harrie; Castelein, René M.; Schlösser, Tom P. C.; Gast, Arthur de

doi:10.1007/s00402-021-03982-1

Cited by 14 publications

(12 citation statements)

References 63 publications

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“…Another important factor that adds to the stability of the hip prosthesis is the position of the femoral component, more specifically the version. A low combined anteversion is associated with posterior dislocation, whereas a high combined anteversion is associated with anterior dislocation [ 15 ]. Due to the ipsilateral knee arthrodesis, a “classic” figure of four positioning of the leg was not possible.…”

Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Follet¹,

Verhelst²,

Ghijselings³

et al. 2023

JOCR

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Introduction: We present a case report of a total hip arthroplasty (THA) in a patient with ipsilateral knee arthrodesis. The direct anterior approach (DAA) was used, and to our knowledge, this has never been described previously in the literature. The purpose of this report is to highlight pre-, per-, and post-operative challenges using the DAA in these rare cases. Case Report: This case report presents the case of a 77 year old female patient with degenerative hip disease in the presence of an ipsilateral arthrodesis of the knee. The patient was operated using the DAA. No complications were found and the patient had an excellent follow-up with a forgotten joint score of 93.75 at 1 year. The difficulty in this case consists in finding the correct stem anteversion with the altered knee anatomy. Using pre-operative templating on X-rays, intraoperative fluoroscopy and the posterior femoral neck the hip biomechanics could be restored. Conclusion: We believe that THA in presence of an ipsilateral knee arthrodesis can be safely performed through a DAA. Keywords: THA, DAA, knee arthrodesis.

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Section: Discussionmentioning

confidence: 99%

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Follet¹,

Verhelst²,

Ghijselings³

et al. 2023

JOCR

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“…We hope the data from this study could help to improve the accuracy of surgical navigation systems for total hip arthroplasty (THA) or in the diagnostic work-up of patients with instability after THA, as femoral torsion affects the risk of dislocation and range of motion [38]. Van Correct assessment of femoral torsion is also important when considering a femoral derotational osteotomy, for example in young adults with hip pain due to excessive femoral antetorsion or retrotorsion [4,26], or in patients with malrotation after a diaphyseal femur fracture [24,36].…”

Section: Discussionmentioning

confidence: 99%

“…Reliable assessment of the femoral torsion is not only important for diagnostics and understanding of pathological processes, but also for planning of hip and knee surgery [9,10,38,43]. Femoral torsion assessments are incorporated in three-dimensional (3D) planning software for knee and hip arthroplasty, in which expected values are targeted to obtain optimal femoral component orientation and rotational alignment [20,28].…”

Section: Introductionmentioning

confidence: 99%

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

Van fraeyenhove,

Verhaegen,

Grammens

et al. 2023

J. exp. orthop.

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Purpose There is high variability in femoral torsion, measured on two-dimensional (2D) computed tomography (CT) scans. The aim of this study was to find a reliable three-dimensional (3D) femoral torsion measurement method, assess the influence of CAM deformity on femoral torsion measurement, and to promote awareness for the used measurement method. Methods 3D models of 102 dry femur specimens were divided into a CAM and non-CAM group. Femoral torsion was measured by one 2D-CT method described by Murphy et al. (method 0) and five 3D methods. The 3D methods differed in strategies to define the femoral neck axis. Method 1 is based on an elliptical least-square fit at the middle of the femoral neck. Methods 2 and 3 defined the centre of mass of the entire femoral neck and of the most cylindrical part, respectively. Methods 4 and 5 were based on the intersection of the femoral neck with a 25% and 40% enlarged best fit sphere of the femoral head. Results 3D methods resulted in higher femoral torsion measures than the 2D method; the mean torsion for method 0 was 8.12° ± 7.30°, compared to 9.93° ± 8.24° (p < 0.001), 13.21° ± 8.60° (p < 0.001), 8.21° ± 7.64° (p = 1.00), 9.53° ± 7.87° (p < 0.001) and 10.46° ± 7.83° (p < 0.001) for methods 1 to 5 respectively. In the presence of a CAM, torsion measured with method 4 is consistently smaller than measured with method 5. Conclusion 2D measurement might underestimate true femoral torsion and there is a difference up to 5°. There is a tendency for a higher mean torsion in hips with a CAM deformity. Methods 4 and 5 are the most robust techniques. However, method 4 might underestimate femoral torsion if a CAM deformity is present. Since method 5 is independent of a CAM deformity, it is the preferred technique to define expected values of torsion.

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“…[3][4][5] To reduce the incidence of dislocation, achieving optimal orientation of the implant placement should be prioritised. 6,7 Intraoperative assessment of dislocation is a simple method for predicting instability after THA. 8 The modular femoral neck system has some practical advantages, allowing for the adjust-Anatomical studies have identified morphological differences in the hip joint between men and women.…”

Section: Introductionmentioning

confidence: 99%

Sex-based differences in neck selectivity in total hip arthroplasty using a modular femoral neck system

Shigemura,

Kamikawa,

Yamamoto

et al. 2024

Int J Artif Organs

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Background: Dislocation is a major complication of total hip arthroplasty (THA). The modular femoral neck system provides practical advantages by allowing adjustment of neck version and length in the presence of intraoperative instability. Anatomical studies have identified morphological differences in the hip joint between men and women. Despite sex-based differences in hip morphology, it remains unclear whether such differences affect neck selectivity in THA using a modular neck system and whether this approach achieves anatomical reconstruction, thereby reducing complications such as dislocation. This study aimed to investigate gender differences in neck selectivity in THA with the modular neck system and assess the clinical impact of the modular neck system. Methods: A total of 163 THAs using a modular neck system were included in this study. Data on the type of modular neck and intraoperative range of motion (ROM) were retrieved from patient records. Pre- and post-operative leg length differences (LLD) were examined as part of the radiographic assessment. Dislocation was investigated as a postoperative complication. Results: Neck selectivity did not significantly differ between men and women. The comparison of pre- and post-operative LLD revealed a tendency for varus necks to improve LLD more than version-controlled necks. Furthermore, no significant correlation was found between intraoperative ROM and neck selectivity, or postoperative dislocation and neck selectivity. Conclusions: This study on THA with a modular neck system provided valuable insights into sex-based differences in neck selectivity and highlighted the potential benefits of the modular neck system in addressing LLD and preventing postoperative dislocation.

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The role of the femoral component orientation on dislocations in THA: a systematic review

Cited by 14 publications

References 63 publications

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

Total Hip Arthroplasty through Direct Anterior Approach in a Patient with Ipsilateral Knee Arthrodesis: A Case Report

The quest for optimal femoral torsion angle measurements: a comparative advanced 3D study defining the femoral neck axis

Sex-based differences in neck selectivity in total hip arthroplasty using a modular femoral neck system

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