A neck-preserving short stem better reconstructs the centre of rotation than straight stems: a computed tomography-based cadaver study

Ezechieli, Marco; Matsubara, Masaaki; Budde, Stefan; Wirries, Nils; Sungu, Mevlüt

doi:10.1007/s00402-021-03957-2

Cited by 5 publications

(4 citation statements)

References 19 publications

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“…Addressing this topic, we found that short‐stem THA preserved postoperative femoral antetorsion angles better than conventional‐stem THA. Confirming our results, the authors of a recently published cadaveric study also found better restoration of femoral antetorsion with a metaphyseally anchored short‐stem prosthesis compared with a short straight‐stem and a conventional‐stem prosthesis implanted in femoral specimens 25 . However, in contrast to Ezechieli et al, our study was performed on full‐body cadavers, which represents a more realistic model taking into account the effect of the soft tissues on the femoral antetorsion during implant bed preparation and insertion.…”

Section: Discussionsupporting

confidence: 90%

“…Confirming our results, the authors of a recently published cadaveric also found better restoration of femoral antetorsion with a metaphyseally anchored short-stem prosthesis compared with a short straight-stem and a conventional-stem prosthesis implanted in femoral specimens. 25 However, in contrast to Ezechieli et al, our study was performed on full-body cadavers, which represents a more realistic model taking into account the effect of the soft tissues on the femoral antetorsion during implant bed preparation and insertion. Further in line with our findings, Müller et al also found that conventional-stem THA resulted in a significantly lower postoperative femoral antetorsion angle than the preoperative value (7.4°vs.…”

Section: Discussionmentioning

confidence: 99%

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Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

Hochreiter

Böhm²,

Fierlbeck

et al. 2021

Journal Orthopaedic Research

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Calcar-guided short stems in total hip arthroplasty (THA) permit surgeons to successfully reconstruct postoperative femoroacetabular offset, accurately restore leg length, and adequately re-establish a wide range of caput-collum-diaphyseal angles.However, their effect on femoral antetorsion is less known. Indeed, controlling antetorsion of the femoral stem can be challenging because of the differences in individual femoral geometry and curvature. Therefore, we investigated if calcarguided short-stem THA alters femoral antetorsion and compared it with conventional-stem THA. Using 12 Thiel-fixed, full-body cadaver specimens from donors without known hip disorders, we compared an uncemented calcar-guided femoral short-stem prosthesis with an uncemented conventional straight-stem prosthesis. In a paired study setup, each specimen received a calcar-guided short stem on one side and a conventional stem on the other. On the acetabular side, all specimens received a press-fit, monobloc acetabular cup. Femoral antetorsion angles were measured using the Waidelich method, and pre-and post-operative angles of both sides were recorded. The mean preoperative femoral antetorsion angles were similar in both groups (24.8°± 7.5°vs. 23.8°± 6.1°, p = 0.313). Mean postoperative femoral antetorsion angles were 23.0°± 5.5°in short-stem and 13.5°± 7.1°in conventional-stem hips. Short-stem hips had a small but nonsignificant difference in femoral antetorsion angles pre-and post-operatively (1.8°± 3.2°, p = 0.109), while the difference for conventional-stem hips was much larger and highly significant (10.3°± 5.8°, p < 0.001). Calcar-guided short-stem THA effectively restores femoral antetorsion. However, how this affects long-term clinical outcomes and complications warrants further exploration.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

Hochreiter

Böhm²,

Fierlbeck

et al. 2021

Journal Orthopaedic Research

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“…Since radiological data allowing the measurement of the preoperative anterior offset were not available, it can only be stated that there is a significant difference between the implants, but not which implant achieves more physiological restoration of joint mechanics. However, data from other studies suggest that the short stem leads to a more anatomical reconstruction 6 , 13 .…”

Section: Discussionmentioning

confidence: 96%

“…Since most short hip stems are not available with different CCD angles, the possibility of influence on the lateral femoral offset by adjustments due to the resection height of the femoral neck is limited 5 . The literature suggests a more anatomic reconstruction of the antetorsion angle with a calcar-guided short stem compared to a conventional stem, with the conventional stem introducing an malalignment of around 7° 6 .…”

Section: Introductionmentioning

confidence: 99%

Hip joint function and reconstruction of the anterior femoral offset in patients with short stem vs. conventional THA

Budde

Tonin

Jakubowitz

et al. 2023

Sci Rep

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In cases where mobility and joint function are impaired after implantation of a THA, weakening of hip movement in both extension/flexion and adduction/abduction may play a role due to shortening of the physiological lever arm of the hip muscles. Mechanical factors of influence include the lateral femoral offset, which affects the lever arm, and the antetorsion angle of the hip prosthesis, which affects the anterior femoral offset. This study aimed to investigate the effect of an altered antetorsion angle of the implant on the hip moments and gait patterns of the patient. For this study, 13 patients with a conventional stem on one side and a calcar-guided short stem implanted on the contralateral side were included. To determine the maximum hip moment, tests were performed on a dynamometer in extension/flexion and adduction/abduction in addition to gait analysis. As a control, a comparison was made with data from a reference group of 30 healthy subjects. Both implants showed similar symmetry indices. There was a significant difference between the implants for adduction moments (p < 0.001). The ratios between the directions of moments showed no significant differences. The joint function measured by isokinetic measurements and gait analysis remains comparable to the healthy control group after short stem arthroplasty, but shows slight changes after conventional stem arthroplasty.

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Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis

Weenders,

Merfort,

Eschweiler

et al. 2023

International Orthopaedics (SICOT)

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A neck-preserving short stem better reconstructs the centre of rotation than straight stems: a computed tomography-based cadaver study

Cited by 5 publications

References 19 publications

Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

Femoral antetorsion after calcar‐guided short‐stem total hip arthroplasty: A cadaver study

Hip joint function and reconstruction of the anterior femoral offset in patients with short stem vs. conventional THA

Ten-year follow-up and clinical outcome of a metaphyseal anchoring short hip stem prosthesis: a retrospective single-centre analysis

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