Combined Anteversion Technique for Total Hip Arthroplasty

Dorr, Lawrence D.; Malik, Aamer; Dastane, Manish; Wan, Zhinian

doi:10.1007/s11999-008-0598-4

Cited by 402 publications

(382 citation statements)

References 31 publications

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“…This is quite a significant finding, as an unfavourable combined cup-stem alignment has a proven influence on the risk of impingement, the maximum range of motion, the extent of wear and dislocation or loosening [1,6]. According to our study data, cup and stem should be implanted at a defined combined anteversion [4]. Depending on gender, a combined anteversion of 25-35°f or men and 35-45°for women is desirable [12].…”

Section: Discussionmentioning

confidence: 71%

“…Other authors have also demonstrated a relative anteversion variance when using a noncemented straight stem whose average anteversion was 16°, with a variance from 30°retroversion up to 45°a nteversion [4]. The relative scattering of the anteversion can be substantiated by the fact that the torsion of a noncemented straight stem due to press-fit anchoring is influenced by the individual structure of the femoral bone, the shape of the femur itself, femoral neck torsion and anterior bowing of the femur [3,10].…”

Section: Discussionmentioning

confidence: 99%

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The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

Müller

Crucius

Perka

et al. 2010

International Orthopaedics (SICOT)

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Adequate stem alignment is essential for the success of Total Hip Arthroplasty (THA) to avoid dislocation and impingement. One factor that has not been sufficiently investigated so far is the stem tilting in the sagittal plane, which has an influence on the position of the centre of the femoral head and thus also on prosthesis torsion. We aimed to evaluate sagittal stem position using 3D-CTs in patients with THA and to develop a mathematical-geometrical model to simulate the functional correlation between sagittal stem tilting and the influence on functional anteversion. Thirty patients with THA underwent a CT-scan. By 3D-reconstruction of the CT-data, femoral-/prosthesis-axis, torsion and sagittal tilt were determined. In accordance with the position of the femoral and prosthesis axes, the rotatory (rAV) (surgically adjusted) and functional (depending on sagittal tilt) anteversion (fAV) was measured. A three dimentionalcoordinate transformation was also performed using the Euler-angles to derive a mathematical-geometrical correlation between sagittal stem tilting and corresponding influence on anteversion. The mean rAV was 8°(-11.6 -26°), the fAV 18°( 6.2 -37°), and the difference 10°(8.8 -18°). The mean degree of stem tilting was 5.2°(0.7 -9°) anterior towards the femoral axis. The individually measured parameters are reflected in the mathematical-geometrical model. Depending on the extent of the sagittal deviation, a clear influence on the torsion emerges. For example, a stem implanted at a 15°a nteverted angle with a sagittal tilt by two degrees towards anterior results in a fAV of 20°. A clear association between the sagittal stem alignment and the impact on the fAV was demonstrated. Hence, the rotatory anteversion intended by the surgeon may be functionally significantly different. This might pose an increased risk of dislocation or impingement. The sagittal tilt of the prosthesis should therefore be considered in the context of impingement and dislocation diagnosis. In this respect, we recommend a 3D-analysis of stem alignment.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

Müller

Crucius

Perka

et al. 2010

International Orthopaedics (SICOT)

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“…The hemispheric reamer was only partially engaged in the acetabular bone. In 83 hips, femoral preparation was performed first to estimate the femoral stem anteversion and the cup anteversion was adjusted for a combined anteversion of 25°to 45° [10]. In 123 hips, the acetabulum was targeted to 20°to 25°of anteversion and prepared first.…”

Section: Methodsmentioning

confidence: 99%

Failure of the Durom Metasul® Acetabular Component

Long

Dastane

Harris

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Large-diameter metal-on-metal articulations reportedly provide better stability and range of motion than smaller diameter bearings. We therefore asked whether a large-diameter (44-to 50-mm) metal-on-metal articulation (Durom1) would eliminate dislocation and provide similar functional scores and clinical and radiographic failure rates as those with 28-mm articulation. We prospectively followed 181 patients (207 hips) who had a large-diameter articulation implanted between May 2006 and November 2007. We compared these patients with a historical control of 54 patients who had a small-diameter (28-mm Metasul1) articulation. All patients had a Harris hip score and a self-assessment of outcome and radiographic followup. The minimum followup was 1 year (mean, 1.6 years; range, 1-2 years). During the followup period, we performed revisions on 29 patients (30 hips [15%]) with 21 of 29 (72%) having radiographic criteria of loosening. Thirteen retrieved cups and acetabular tissue were examined histologically. Twenty-eight of 151 unrevised patients had radiographic impending failure; 12 without revision had clinical failure. Eight patients (nine hips) had both clinical failure and impending radiographic failure. Cup inclination was 41.3°± 5.4°and anteversion was 20.2°± 7°. The revision rate and quality of clinical results were unacceptable as compared with our historical controls. We do not recommend use of the Durom1 implant.

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“…Firstly, we only investigated patients using a single THA system. The uncemented femoral implants in this study tend to follow the normal anatomy of the proximal femur, limiting adjustability over stem orientation [25]. Secondly, the intended component positions of individual patients might be different.…”

Section: Discussionmentioning

confidence: 99%

Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis

Tsai

Dimitriou

et al. 2014

International Orthopaedics (SICOT)

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Purpose Component orientations and positions in total hip arthroplasty (THA) are important parameters in restoring hip function. However, measurements using plain radiographs and 2D computed tomography (CT) slices are affected by patient position during imaging. This study used 3D CT to determine whether contemporary THA restores native hip geometry. Methods Fourteen patients with unilateral THA underwent CT scan for 3D hip reconstruction. Hip models of the nonoperated side were mirrored with the implanted side to quantify the differences in hip geometry between sides. Results The study demonstrated that combined hip anteversion (sum of acetabular and femoral anteversion) and vertical hip offset significantly increased by 25.3°±29.3°( range, −25.7°to 55.9°, p=0.003) and 4.1±4.7 mm (range, −7.1 to 9.8 mm, p=0.009) in THAs. Conclusions These data suggest that hip anatomy is not fully restored following THA compared with the contralateral native hip.

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Combined Anteversion Technique for Total Hip Arthroplasty

Cited by 402 publications

References 31 publications

The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

Failure of the Durom Metasul® Acetabular Component

Does total hip arthroplasty restore native hip anatomy? Three-dimensional reconstruction analysis

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