Computed tomography evaluation of hip geometry restoration after total hip resurfacing

Arnould, A.; Boureau, F.; Benad, K.; Pasquier, Gilles; Migaud, Henri; Girard, Julien

doi:10.1016/j.otsr.2015.04.004

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…Cup anteversion was measured in the axial plane as the angle between the transverse cup axis and the sagittal plane. Stem anteversion was measured in the axial plane relative to the posterior bicondylar plane of the femur [20].…”

Section: Implant Alignmentmentioning

confidence: 99%

Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

2021

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Background This study aims to evaluate postoperative pain and functional and clinical outcomes of anterolateral supine (ALS) and posterolateral (PL) approaches for primary total hip arthroplasty. Materials and methods We retrospectively examined the joints of 110 patients who underwent primary total hip arthroplasty (THA). The ALS group was compared with the PL group using the pain visual analog scale (VAS) and narcotic consumption as pain outcomes. Functional outcomes included postoperative range of motion (ROM) of hip flexion, day on which patients could perform straight leg raising (SLR), day on which patients began using a walker or cane, duration of hospital stay, rate of transfer, and strength of hip muscles. Clinical outcomes included pre and postoperative Harris Hip Scores. Results No significant differences were found in the pain VAS scores or narcotic consumption between the two groups. The PL group could perform SLR earlier than the ALS group (P < 0.01). The ALS group started using a cane earlier (P < 0.01) and had a shorter hospital stay (P < 0.01) than the PL group. Degrees of active ROM of flexion at postoperative day (POD) 1 were significantly lower in the ALS group than in the PL group (P < 0.01). Regarding hip muscle strength, hip flexion was significantly weaker in the ALS group than in the PL group until 1-month POD (P < 0.01). External rotation from 2 weeks to 6 months postoperatively was significantly weaker in the PL group than in the ALS group (P < 0.01). Conclusion The ALS approach was more beneficial than the PL approach because ALS enabled better functional recovery of the strength of external rotation, improved rehabilitation, and involved a shorter hospital stay. Level of Evidence Level IV retrospective observational study.

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Section: Implant Alignmentmentioning

confidence: 99%

Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

2021

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“…21,22,25 Moreover, pathological alterations in the periprosthetic bone such as osteolytic lesions may be less obvious on 2-dimensional x-rays compared to 3-dimensional CT scans. [29][30][31] Hence, accurate interpretation of radiographic changes after HRA requires not only experienced eyes but also a reference frame for assessment and comparison. A 1st attempt to establish a zonal system with 3 zones around the femoral stem proved to deliver insufficient detail for the follow-up of specific features associated with HRA such as neck narrowing.…”

Section: Discussionmentioning

confidence: 99%

“…33 Finally, for the assessment of periprosthetic bone and possible osteolytic lesions behind the acetabular component, computed tomography (CT) scans are much more discriminative than MRI for the evaluation of bone defects and also enable an accurate 3D assessment of the positioning of the components. [29][30][31] However, as for MRI metal scatter may complicate the reading and interpretation of the images. Ultrasound is another valuable method for diagnosis and follow-up of ALTR but requires specific experience in possible soft tissue changes following hip replacement, is less specific than MRI 21 and does not enable evaluation of bone lesions.…”

Section: Discussionmentioning

confidence: 99%

Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip

et al. 2019

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Introduction: Hip resurfacing (HRA) requires a new standardised radiographic evaluation protocol. Evaluation of acetabular components is similar to total hip arthroplasty (THA) but femoral components require different criteria. This study evaluates the efficacy of a new femoral zonal system for radiographic HRA assessment in identifying clinical problems. Methods: A new proximal femoral zonal system divides implant-cement-bone interfaces at head and neck into 7 DeSmet zones. 611 in situ and 100 revised HRA were assessed for component positioning, borderline findings (reactive lines, cortical thickening, cancellous condensation) or sinister findings (lucent lines, bone resorption, osteolysis). Findings were correlated with gender, size, implant survival, clinical scores, metal ions, and adverse soft tissue reactions (ALTR). Results: Radiological changes were found in 265 hips (37.3%), 154 sinister (21.7%) and 111 borderline (15.6%). 84% of revisions had sinister findings versus 11.4% of in situ HRA ( p < 0.001). The mean number of abnormal acetabular and femoral zones was 3.3 in revised compared to 0.6 in situ HRA ( p < 0.001). Sinister findings were associated with female gender, lower clinical scores, smaller sizes or ASR design (all: p < 0.001). Metal ions were higher with sinister ( p < 0.001) and borderline ( p < 0.01) findings compared to normal radiographs. Pathological findings in ⩾4 zones had a sensitivity of 50% and specificity of 94.2% (AUC = 0.898) in detecting hips with ALTR (odds ratio = 49). Conclusion: In order to accurately evaluate progressive radiographic changes in HRA, specific zones have been established around the femoral component. There was a high correlation between radiographic findings and outcome measures. 84% of problematic hips and 90.4% of proven ALTR had sinister changes.

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Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review

Fine¹,

Romagnoli²,

Toscano³

et al. 2017

Orthopaedics & Traumatology: Surgery & Research

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Computed tomography evaluation of hip geometry restoration after total hip resurfacing

Abstract: III, prospective diagnostic case-control study.

Cited by 8 publications

References 25 publications

Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

Comparison of short-term outcomes of anterolateral supine approach and posterolateral approach for primary total hip arthroplasty: a retrospective study

Radiographic evaluation of hip resurfacing: the role of x-rays in the diagnosis of a problematic resurfaced hip

Is there a role for femoral offset restoration during total hip arthroplasty? A systematic review

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