The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu; Lee, Tae Hyun

doi:10.1007/s00402-014-1978-8

Cited by 7 publications

(13 citation statements)

References 19 publications

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“…Influenced by the various lateral inclination of the femur, we can hardly make the measurement on a consistent CT section. Besides, the midcortical line of the cutting surface varied with the cutting height, which also increased the difficulty for preoperative estimation on CT scan [ 14 , 30 ]. Therefore, we supposed that intraoperative estimation of femoral anteversion cannot be totally replaced by preoperative measurement.…”

Section: Discussionmentioning

confidence: 99%

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

et al. 2021

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Background Placement of femoral stem in excessive anteversion or retroversion can cause reduced range of motion, prosthetic impingement, and dislocation. The aim of this study was to assess the operative femoral anteversion in patients treated with total hip arthroplasty (THA) and analyze the need of adjusting stem anteversion. Methods We retrospectively included 101 patients (126 hips) who underwent cementless THA with a manual goniometer to determine the femoral anteversion between October 2017 and December 2018. The operative femoral anteversion we measured was recorded during THA. We further divided those hips into three subgroups based on the range of operative femoral anteversion: group 1 (<10°), group 2 (10–30°), and group 3 (>30°) and compared the differences of their demographic data. Univariate and multivariate logistic regression were used to identify the influencing factors for the need of neck-adjustable femoral stem. The clinical and radiographic outcomes were also assessed. Perioperative complications were recorded. Results After THA, the Harris hip scores improved from 52.87 ± 15.30 preoperatively to 90.04 ± 3.31 at the last follow-up (p < 0.001). No implant loosening, stem subsidence, and radiolucent lines were observed on radiographs. No severe complications occurred and no components needed revision at the latest follow-up. The mean operative femoral anteversion was 14.21° ± 11.80° (range, −9 to 60°). Patients with femoral anteversion more than 30° were about 10 years younger than others. Femoral anteversion >30° was more common in patients with developmental dysplasia of the hip (DDH). There were totally 14 hips treated with the neck-adjustable femoral stem. From the univariate analysis, we can observe that female sex, diagnosis of DDH (compared with osteonecrosis), and higher operative femoral anteversion and its value >30° (compared with <10°) are associated with higher rates of using the neck-adjustable femoral stem. However, all these factors were no longer considered as independent influencing factors when mixed with other factors. Conclusions This study highlighted the significance of operative femoral anteversion. Identification of abnormal femoral anteversion could assist in adjusting stem anteversion and reduce the risk of dislocation after THA.

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Section: Discussionmentioning

confidence: 99%

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

et al. 2021

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“…It was defined as the line connecting the central part of the intercondylar notch and trochanteric fossa. [14] The posterior condylar line was the line which connected the posterior condyles of distal femur (Fig. 3).…”

Section: Methodsmentioning

confidence: 99%

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Han

Zhang²,

Wang³

et al. 2019

Medicine

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Conventional methods have limitations in measuring femoral neck torsion angle (FNTA) of patients with femoral deformities. A new method of three-dimensional (3D) reconstruction technology based on computer tomography (CT) was proposed to enhance measurement accuracy and applicability in this study.Bilateral FNTA of 50 developmental dysplasia of the hip (DDH) patients (DDH group) and 81 volunteers (normal group) were measured by Mimics software based on CT data with the marker lines determined by centerline and curvature. Each FNTA was measured by observer A and observer B for twice separately. 50 DDH patients were classified into 3 groups (group I, II, III) according to Hartofilakidis classification. The statistical analysis of the differences was made among the measurements of the FNTA.The FNTA values were 27.56° ± 12.48° in DDH group and 21.22° ± 8.14° in normal group with significant difference (t = 4.516, P < .001). The FNTA values were 24.53° ± 2.40° in group I, 29.78° ± 1.83° in group II and 39.08° ± 3.13° in group III, with significant difference (F = 7.568, P = .001).The accuracy, reliability and applicable scope of FNTA measurement can be improved by 3D reconstruction in clinical practice. The applicable scope of this method included normal people and patients with femoral deformities. The FNTA of DDH patients is significantly larger than normal volunteers with a positive correlation between the severity of classification. This study will also provide references for preoperative design of Chinese population.

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“…[23] Recently, Weber et al reported measurement methods of the stem version on anteroposterior (AP) radiographs using a computer program and mathematical formulas. [24]- [25] However, this method required a true lateral radiograph with highly standardized technique for its precise measurement and it is difficult to differentiate between anteversion and retroversion.…”

Section: Introductionmentioning

confidence: 99%

Trans-lateral Decubitus Radiograph of the Hip: A New View to Measure the Version of the Femoral Stem

Yoo

Ahn

et al. 2019

Preprint

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Background We developed a radiological method, trans-lateral decubitus view, to measure stem version and assessed its reliability as well as the validity.Methods Trans-lateral decubitus view of the hip was a lateral radiograph, which was taken with the patient in lateral decubitus position, hip extension, 90° knee flexion and patella facing forward. In 40 patients, who underwent total hip replacement (THR), a trans-lateral decubitus view and CT scan of the hip were taken. Three observers measured stem neck-shaft angle (α) on hip AP view, and the stem anteversion (β), which was the angle between the axis of stem neck and axis of the femur, on the trans-lateral decubitus view. The stem version (θ) was calculated using the formula; θ = arc ((tan (180°-β) /tan (180°-α)). The intra and inter-observer reliabilities of each measurement were examined. The radiological measurements were compared with those on the CT scan to evaluate their validity.Results The mean stem anteversion on radiological measurement was 23.72° (SD 8.17) and the mean CT measurement was 23.91° (SD 10.25) (p = 0.929). The intra- and interobserver reliabilities of the radiological measurements were 0.934 and 0.931, respectively. Those of CT measurements were 0.941 and 0.942, respectively. When the radiological anteversion was between -30° and 30°, the correlation coefficient between radiological measurements and CT measurements was 0.729 (p = 0.001).Conclusion The trans-lateral decubitus method appears reliable and valid for the measurement of femoral stem version. Trial Registration: NCT02554149 (29 March 2016).

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The T-line as an intraoperative landmark for reproducing the native femoral anteversion during hip arthroplasty

Abstract: Aligning the stem parallel to the T line on the cut surface provides a good reproduction of the femoral anteversion. The T line can be an useful intraoperative reference guide for the anteversion of the femoral component in THA for patients without severe hip deformity.

Cited by 7 publications

References 19 publications

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

Measurement of operative femoral anteversion during cementless total hip arthroplasty and influencing factors for using neck-adjustable femoral stem

Application of three-dimensional reconstruction to improve the preoperative measurement accuracy and applicability of femoral neck torsion angle

Trans-lateral Decubitus Radiograph of the Hip: A New View to Measure the Version of the Femoral Stem

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