Effect of altered proximal femoral geometry on predicting femoral stem anteversion in patients with developmental dysplasia of the hip

Huang, Chenhui; Tan, Hua-Qiao; Kernkamp, Willem A.; Cheng, Rongshan; Liang, Jianying; Zhu, Zhenan; Baek, Seung‐Hoon; Wang, Liao; Tsai, Tsung‐Yuan

doi:10.1186/s13018-019-1491-4

Cited by 8 publications

(8 citation statements)

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“…We found the AM-CT at 10 mm height was better than that at 5 mm for predicting the PSA for DDH patients. These results may be because morphological characteristics of the distal femoral medullary cavity in DDH femurs tend to be more circular or elliptical ( 6 , 22 ), which created more difficulties in confirming the anterior and posterior cortex. Therefore, 5 mm height proximal to the base of the lesser trochanter of the CT slices may cause a slight deviation in confirming the midcortical-line compared to the 10 mm height group.…”

Section: Discussionmentioning

confidence: 99%

“…Appropriate postoperative stem anteversion (PSA) in total hip arthroplasty (THA) is critical to achieving implant stability, the optimal range of motion (ROM), and avoiding impingement (1)(2)(3)(4)(5)(6)(7)(8). The combined anteversion technique, which considers the sum of acetabular cup anteversion and femoral anteversion, has been clinically proven to prevent implant impingement if controlled in a safe zone of 25°-50° (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

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The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty

et al. 2022

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BackgroundPrecise preoperative planning improves postoperative outcomes in total hip arthroplasty (THA), especially in developmental dysplasia of the hip (DDH) cases. Previous studies used the T-line and midcortical-line as preoperative landmarks to predict postoperative stem anteversion (PSA). However, the most reliable landmark in predicting PSA in DDH patients remains unclear. To find the most reliable measurement to predict the PSA in DDH patients, this study compared the midcortical-line and T-line at different femoral neck levels.MethodsPre- and postoperative Computed Tomography (CT) scans of 28 hips in 21 DDH patients who received THA were obtained for three-dimensional femoral models. The preoperative CT scan was used to measure the anteversion of the midcortical-line on the axial cross-sectional plane images (AM-CT), the anteversion of the midcortical-line from 3D models (AM-3D), and the T-line from 3D models (AT-3D) at simulated osteotomy planes at 5 and 10 mm heights proximal to the base of the lesser trochanter. The correlation between the preoperative femoral anteversion (AM-CT, AM-3D, AT-3D) and the PSA was assessed to evaluate the prediction accuracy.ResultsThe correlations between the AM-CT and the PSA were 0.86 (mean difference (MD) = 1.9°) and 0.92 (MD = −3.0°) at 5 and 10 mm heights, respectively. The correlation between the AM-3D and the PSA were 0.71 (MD = −11.6°) and 0.61 (MD = −12.9°) at 5 and 10 mm heights. The AT-3D was significantly greater (MD = 15.4°) than the PSA (p-value <0.01) at 5 mm cutting height, and the correlation between the AT-3D and the PSA was 0.57 (MD = 7.8°) at 10 mm cutting height.ConclusionsThe AM-CT at the 10 mm height had the strongest correlation with the PSA and was more reliable in predicting the PSA when compared with the AM-3D and the AT-3D in DDH patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty

et al. 2022

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“…Moreover, Huang et al found that the version of calcar femorale or canal version at the inferior femoral neck, and canal version at CLT level all exhibited a strong positive correlation with stem version in patients with DDH. 30 However, CLT is a bony structure deviating from the main femoral canal, which cannot reflect the true axis of femoral canal. Besides, Tetsunaga et al demonstrated that the morphology of calcar femorale differed according to the severity of hip deformity, which made it less reliable to predict the stem version.…”

Section: Explorations For Better Preoperative Radiographic Methods To...mentioning

confidence: 99%

Comparison of Preoperative Computed Tomography and Intraoperative Estimation in Predicting the Version of a Single‐Wedge Femoral Stem

Sun

Zhang

Shen

et al. 2022

Orthopaedic Surgery

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Objective Early prediction of stem version aids in optimization of combined version during total hip arthroplasty (THA). This study aimed to analyze the discrepancy between stem version and native femoral version measured by different methods, and to explore which method can better predict the stem version. Methods We retrospectively reviewed 26 patients (39 hips) treated with robot‐assisted THA in our hospital between September 2019 and December 2019. A straight, single‐wedge, cementless stem (Accolade II) was used in all cases. Preoperative femoral version was measured at three levels on computerized tomography (CT) scan from the top to the middle level of femoral neck (Level 1 to Level 3). During THA, the version on cutting surface was measured prior to femoral broaching based on two reference lines: mid‐cortical line and T line (trochanteric fossa to the middle of medial cortex). After femoral broaching, stem version was measured based on the femoral neck trial using Mako system (Stryker). In the statistical analysis, the difference and absolute discrepancy between stem version and femoral version measured with various methods were examined using paired t‐test, and the relationship between stem version and various femoral versions were examined using correlation analysis. Results Mean femoral neck version (Level 1) was 9.5° ± 2.6° (range, −16.8°‐42.5°), while mean stem version measured by Mako system was 19.9° ± 2.0° (range, −8.0°‐49.0°). Femoral version measured with each method showed a moderate correlation with stem version (p < 0.05). There was a significant difference between stem version and femoral version except at Level 3, with a mean difference of 0.8° ± 13.6° (p = 0.729). With regard to the intraoperative estimation, stem version significantly increased compared to the value based on mid‐cortical line, with a mean difference of 8.4° ± 13.1° (p < 0.001). However, the mean value of stem version was a little smaller than that of femoral version measured by reference to T line, but without statistical significance (p = 0.156). No postoperative dislocations occurred during the study period. No revision was required for any component. Conclusions The middle level of femoral neck on CT scan and T line on cutting surface are better references to measure femoral version for predicting postoperative stem version. However, the relationship between stem version and predictive value was flexible. Therefore, further three‐dimensional studies of postoperative CT are needed to validate the press‐fit fixation and rotational freedom of the single‐wedge stem.

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“…This difference may carry through to hip geometry in older adults. Moreover, complying with hip geometry when performing hip fracture surgery is essential for the outcome [ 16 ], and knowledge of hip geometry in older adults is necessary.…”

Section: Introductionmentioning

confidence: 99%

Hip geometry in hip fracture patients in Greenland occurring over a 7.7-year period

2021

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Background Hip geometry influences hip fracture risk. Hip fractures are common, and they are associated with pain, disability, premature death and marked costs on society. Osteoporotic fractures are frequent in Arctic populations and increase with advancing age in this society with a steep rise in life expectancy. Greenland Inuit is a distinct ethnic group, and data on hip geometry is missing. We thus aimed to describe hip geometry in 7.7 years of consecutive hip fracture patients in Greenland. Methods We evaluated collodiaphysial angle, femoral neck length, the outer and inner diameter of the femur at 2 and 5 centimetres below the centre of the lesser trochanter and the cortical thickness from pelvic and hip radiographs in all patients operated in Greenland over 7.7 years. We included all 84 patients with one non-fractured hip visible for geometric analysis. Analyses were conducted in duplicate. Results We found a collodiaphysial angle of 134.8/132.6o in men/women (p = 0.06) and a femoral neck length of 38.0/33.9 mm in men/women (p = 0.001). Cortical thickness was affected by sex in the adjusted analysis (p < 0.001). Cortical thickness index at 5 cm below the centre of the lesser trochanter decreased with age (p = 0.026) and may be influenced by height (2 cm below the centre of the lesser trochanter, p = 0.053). Conclusion Our findings differed from European data and suggest a delicate balance in hip geometry in Arctic populations. Ethnic peculiarities influence the structure of the hip and may influence fracture risk. A focus on hip geometry and risk factors for osteoporotic fractures in Arctic populations is warranted.

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Effect of altered proximal femoral geometry on predicting femoral stem anteversion in patients with developmental dysplasia of the hip

Cited by 8 publications

References 24 publications

The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty

The midcortical-line is more reliable than the T-line in predicting stem anteversion in patients with developmental hip dysplasia after total hip arthroplasty

Comparison of Preoperative Computed Tomography and Intraoperative Estimation in Predicting the Version of a Single‐Wedge Femoral Stem

Hip geometry in hip fracture patients in Greenland occurring over a 7.7-year period

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